AUTHOR=Isazade Vugar , Yehia Asmaa , Sharma Umesh M. , Zhang Nan , Schneekloth Terry , Abulseoud Osama A. 

TITLE=Alcohol withdrawal in patients with liver disease

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1569499

DOI=10.3389/fpsyt.2025.1569499

ISSN=1664-0640

ABSTRACT=ObjectiveThis study investigated and compared the clinical characteristics and treatment outcomes of alcohol withdrawal syndrome (AWS) in patients with and without liver diseases.MethodWe conducted a retrospective chart review of all hospital admissions that received the CIWA-Ar protocol at the Mayo Clinic Health System between June 2019 and June 2022.ResultsIn this retrospective cohort study, we analyzed data for 1,586 hospitalizations for 811 liver disease [LIV(+)] patients and compared the results with 14,604 hospitalizations for 9,281 patients without liver disease [LIV(-)].Compared to the LIV(-) group, LIV(+) patients had more alcohol use disorder (94.3% vs. 58%, P = 0.003), longer hospital length of stay [Median (25th, 75th percentiles): 93 (51,173) vs. 69 (43,125) hours, P = 0.001], longer time to reach peak CIWA-Ar scores [Mean ± SD: 26.3 ± 35.9 vs. 2.4 ± 32.5 hours, P = 0.001], lower first 24 hours lorazepam dose equivalents [3.5 (1.5, 7) vs. 3.5 (1.5, 8) mg, P = 0.001], and higher mortality rates (16.8% vs. 5.8%, P = 0.001). Within the LIV (+) cohort, no sex difference was depicted except for longer time to reach peak CIWA in males (Mean ± SD: 28.5 ± 40.3 vs. 21.7 ± 24.5 hours, P = 0.014).ConclusionsOur study highlights the higher mortality, hospital LOS, and ICU admissions in patients with liver cirrhosis and hepatic failure. We also recommend further controlled studies to examine the severity of AWS in hepatic patients, using other tools besides CIWA-Ar.