Fewer Than Half of Patients with Alcohol Use Disorder Received Recommended Care in ICU, Researchers Find

Only 51 percent of patients received brain-protective vitamin supplement in nationwide study

Thiamine, also known as vitamin B1, plays an important role in cells throughout the body. Alcohol use is a well-recognized and important risk factor for thiamine deficiency, which – if left untreated – can lead to brain and cognitive impairment, including an alcohol–linked neurological disorder known as Wernicke–Korsakoff syndrome (WKS). Various guidelines, including those of the European Federation of Neurological Societies and the American Society of Addiction Medicine, recommend the use of thiamine supplementation to prevent brain injury in patients with alcohol use disorder.

In a nationwide retrospective observational study published in Annals of Internal Medicine, researchers at Beth Israel Deaconess Medical Center (BIDMC) demonstrated that approximately half of the patients admitted to ICUs with alcohol use disorder did not receive thiamine supplementation. The finding highlights a potential area for quality improvement in care of patients presenting to a hospital with alcohol use disorder.

“Alcohol use disorder is the most common risk factor for thiamine deficiency in North America, Europe and Australia, and patients with septic shock, traumatic brain injury and diabetic ketoacidosis have also been shown to be at risk,” said leading author Rahul D. Pawar, MD, an internal medicine physician at BIDMC. “Thus, it is possible that critically ill patients with alcohol use disorder are especially at risk for thiamine deficiency and would benefit from thiamine supplementation.”

Pawar and colleagues used deidentified data from a large, multicenter and nationally representative data set in the United States to characterize the incidence of thiamine supplementation between 2010 and 2017 across various illness categories, including alcohol withdrawal, septic shock, traumatic brain injury and diabetic ketoacidosis. The study included data from 14,998 patients, 17 years of age or older, who were directly admitted to intensive care from the emergency department for treatment of alcohol use disorder or alcohol use disorder-attributable conditions. Overall, the team observed that just over half of all patients received thiamine.

“Our study highlights a potential opportunity for improving care for patients with alcohol use disorder with critical illnesses in the United States,” said senior author Michael Donnino, MD, a critical care and emergency medicine physician at BIDMC and a professor of emergency medicine at Harvard Medical School. “Measures that could potentially help increase the provision of thiamine for critically ill AUD patients might include automatic flags triggered in the online medical record such that providers are alerted to such patients and prompted to consider giving thiamine.”

To learn more and to see a complete list of coauthors and disclosures, read the full study published in Annals of Internal Medicine.

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