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A6048 - Critically Ill Caucasian Patients Admitted for Alcohol Withdrawal Have a Longer Hospital Length of Stay and Receive Higher Doses of Benzodiazepines
Author Block: N. Ghionni1, A. M. Abdul Hameed2, B. E. Iriarte3, A. Malik1, A. Maheshwari1, D. J. Valentino, III4; 1Mercy Catholic Medical Center, Darby, PA, United States, 2Internal Medicine, Mercy Catholic Medical Center, Darby, PA, United States, 3INTERNAL MEDICINE, MERCY CATHOLIC MEDICAL CENTER, DARBY, PA, United States, 4Mercy Catholic Medical Center, Mercy Catholic Medical Center, Darby, PA, United States.
Introduction: Benzodiazepines (BZD) have well-known adverse effects. Clinical tools such as the Clinical Institute Withdrawal Assessment (CIWA-ar) score allow healthcare professionals use appropriate amounts of medications in dangerous circumstances such as acute alcohol withdrawal. We investigated variables such as hospital length of stay, ICU length of stay, and amount of benzodiazepine used. The study variables were compared between racial groups to identify any differences.
Methods: A retrospective observational study in two adult mixed medical/surgical/cardiac intensive care units (ICU) at two academic community hospitals in an urban/suburban setting was conducted from August 2015 to September 2017. Baseline patient demographics, co-morbidities, and clinical characteristics were collected. We measured the total amount of BZDs given for acute alcohol withdrawal in the time period before and after CIWA-ar scoring was instituted. Length of stay was recorded in days. 159 patients were then stratified to 2 primary ethnic groups Caucasian versus African-American and other racial groups. Study variables were compared using an unpaired t-test.
Results: Study population consisted of predominantly middle aged (mean=53 years), male (80%), African American or other ethnicity (75%) patients. The Caucasian population had a higher median age (age=57) versus African-American and other populations. Median APACHE II scores were similar in both groups. We found that Caucasians received statistically significant higher median BZD doses both pre CIWA (2mg vs 8mg, p=0.01) and post CIWA (11mg vs 25.25mg, p=0.03) when compared to African-Americans and other ethnic groups. Caucasians had similar median CIWA scores when compared to African-Americans and other ethnic groups. This difference was not statistically significant (9.5 vs 5, p=0.06). Furthermore, we discovered that Caucasians were found to have statistically significant higher hospital length of stay when compared to African-American and other ethnic groups (5.25 days vs 4 days, p=0.001). Median ICU length of stay was similar in both groups (3 days).
Conclusion: In this cohort, we found that Caucasian patients admitted to the ICU for alcohol withdrawal had a significantly longer hospital length of stay and had a trend towards receiving higher BZD doses. Concomitant drug ingestion, comorbidities, or other social and disposition issues could contribute to higher length of stays for Caucasians. Furthermore, recent pharmacokinetic data suggests that certain individuals’ genetic polymorphisms for enzymes that degrade BZD varies widely. Future research should investigate whether these differences are can be found in certain populations as this can affect mean concentration of benzodiazepines, volume of distribution, and elimination rates.