A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS. Patients (n = 127) presen...

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Published in:	Journal of translational medicine Vol. 17; no. 1; p. 384
Main Authors:	Maguire, Donogh, Talwar, Dinesh, Burns, Alana, Catchpole, Anthony, Stefanowicz, Fiona, Robson, Gordon, Ross, David P, Young, David, Ireland, Alastair, Forrest, Ewan, Galloway, Peter, Adamson, Michael, Colgan, Eoghan, Bell, Hannah, Orr, Lesley, Kerr, Joanna-Lee, Roussis, Xen, McMillan, Donald C
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 21-11-2019 BioMed Central BMC
Subjects:	Albumin Alcohol withdrawal Alcohol withdrawal syndrome (AWS) Alcoholism Analysis Biochemistry Blood levels Circulating thiamine diphosphate (TDP) Dehydrogenases Emergency medical services Enzymes Glasgow modified alcohol withdrawal scale (GMAWS) Glucose Hypoxia Lactates Lactic acid Magnesium Metabolism Mortality Patient outcomes Patients Plasma lactate concentrations Pseudo-hypoxia Pyrimidines Seizures (Medicine) Serum magnesium concentration Substance withdrawal syndrome Thiamine Thiamine diphosphate United Kingdom Vitamin B Vitamin deficiency Vitamins United Kingdom United Kingdom > UK United States > US Scotland Circulating thiamine diphosphate (TDP) Glasgow modified alcohol withdrawal scale (GMAWS) 1-year mortality Pseudo-hypoxia Plasma lactate concentrations Seizure kindling Serum magnesium concentration Alcohol withdrawal syndrome (AWS)
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Summary:	Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS. Patients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded. The majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275-675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05). The prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	1479-5876 1479-5876
DOI:	10.1186/s12967-019-02141-w