History of delirium tremens associated with greater mortality and morbidity risk than alcohol dependence alone

1. Patients with a history of treated delirium tremens (DT) are at higher risk for all-cause mortality and alcohol-related morbidities compared to patients with just alcohol dependence (AD) or other alcohol withdrawal states (AWS), during a mean follow-up period of less than 1 year.

Evidence Rating Level: 2 (Good)

An estimated 3 to 15% of patients with alcohol use disorder (AUD) experience delirium tremens (DT), a potentially fatal form of alcohol withdrawal characterized by confusion, hallucinations, hypertension, tachycardia, and seizures. While the short-term outcomes of DT are well-studied, the long-term outcomes including mortality risk are not well-known. Therefore, this cohort study based in Norway aimed to compare the all-cause and cause-specific mortality amongst patients with DT, other alcohol withdrawal state (AWS) patients, and AUD patients with no AWS or DT. The study population consisted of adults with a diagnosis of DT, AWS, or alcohol dependence (AD) in the Norwegian Patient Registry, between 2009 and 2015. The outcomes examined included the percentage who died within the first month of the index episode and within the follow-up period, the crude annual rate of mortality, and alcohol-related morbidity. The follow-up period was from the index event until the end of 2015. In total, there were 2937 episodes of DT, 9168 episodes of AWS, and 537,742 episodes of AD, in 1816, 3993, and 30,478 patients respectively. The mean follow-up period after the index event was 36.2, 37.2, and 43.9 person-months for DT, AWS, and AD patients respectively. The study showed that DT patients had the highest mortality rate in the first month and over the duration of the follow-up period (2.5% and 24.1% respectively, p < 0.001 for both). The crude annual mortality was also highest in DT patients (8.0%) compared to AWS and AD (5.0 and 3.6% respectively). There was greater all-cause mortality risk in DT and AWS patients compared to the reference AD patients (HR 1.56, 95% CI 1.41-1.72 and HR 1.17, 95% CI 1.07-1.27 respectively). When examining causes of mortality, all patients had higher standardized mortality ratios (SMRs) for unnatural than for natural causes of death, particularly for poisoning. DT patients had significantly greater SMR than AD patients, and poisoning as the cause of death was 60 times greater in DT patients than the general population. With regards to alcohol-related morbidities, DT patients more often had admissions for alcohol-related reasons than AD patients, before and after the index event, for reasons including intoxication, pancreatitis, head injury, and liver disease. Overall, this study shows that patients who have a history of treated DT experience rates of mortality higher than patients with other alcohol use-related diagnoses.

Click to read the study in Addiction

Image: PD

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