Assessment of the Treatment for Alcohol Withdrawal Syndrome With and Without Dexmedetomidine: A Retrospective Cohort Study

Abstract

Background: Alcohol withdrawal syndrome (AWS) carries a high risk of morbidity and mortality that often requires critical care admission and monitoring. Dexmedetomidine is a known sedative that can help with patient symptoms and potentially reduce Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) scores. This study looks at two groups - the use of dexmedetomidine versus non-dexmedetomidine - in the management of AWS patients to assess the length of intensive care unit (ICU) stay, length of stay (LOS) in hospital, mortality and readmission rate.

Methods: This retrospective cohort study was conducted at Geisinger Health System, a tertiary care, academic health care system, between January 2016 and December 2022. This study did not require ethics approval according to the Institutional Review Board (IRB). The patients assessed included those aged 18 years or older with a documented CIWA-Ar score requiring admission to the ICU or ICU step-down unit. Exclusion criteria included ICU admission for alternative indications, a prior history of seizure disorder, or patients who left against medical advice.

Results: A total of 994 patients were identified to have met the inclusion criteria; 371 patients were in the non-dexmedetomidine group and 623 in the dexmedetomidine group. Primary outcomes assessed were hospital LOS (5.0 (3.0 - 9.0) vs. 10 (6.0 - 16.0), P < 0.0001) and days in the ICU (1.9 (1.0 - 3.4) vs. 4.9 (2.9 - 9.0), P < 0.0001), respectively. Secondary outcomes assessed were lorazepam equivalent usage, and readmission within 30, 60 and 90 days, which were not statistically significant when accounting for ICU LOS.

Conclusions: Among patients treated for AWS, dexmedetomidine use appeared to be associated with longer hospital and ICU stays, while benzodiazepine requirements remained unchanged. These associations may reflect differences in illness severity, emphasizing the need for future prospective evaluation.