Evidence map›Paper›PMID 40106468›Full record

ArticlePloS one2025

Emergency admission, previous delirium tremens and increased liver stiffness as risk factors for severe alcohol withdrawal - A prospective study.

Tobias Zellner, Jan-Christopher Metzger, Elias Bekka, Matteo Rabaioli, Konrad Stock, Minh-Truc Vo-Cong, Sabrina Schmoll, Eva-Carina Heier, Florian Eyer, Raphael Stich

Abstract read
In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Tobias ZellnerDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.ORCID https://orcid.org/0000-0001-5073-8685
Jan-Christopher MetzgerDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Elias BekkaDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.ORCID https://orcid.org/0000-0001-9958-7769
Matteo RabaioliDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Konrad StockDivision of Nephrology, Ultrasound Section, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Minh-Truc Vo-CongDivision of Nephrology, Ultrasound Section, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Sabrina SchmollDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Eva-Carina HeierDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Florian EyerDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.ORCID https://orcid.org/0000-0002-4753-2747
Raphael StichDivision of Clinical Toxicology and Poison Centre Munich, Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine if increased liver stiffness (ILS) is a risk factor for patients with alcohol withdrawal to develop severe alcohol withdrawal symptoms (SAWS) like delirium tremens (DT) or withdrawal seizures (WS).

methodProspective inclusion of 394 patients undergoing withdrawal treatment between 2013-2021. Laboratory exams, history, physical examination, abdominal sonography with elastography and FibroScan® measurements were performed. Primary endpoint was SAWS defined as DT and/or WS. Patients with >  12.5 kPa stiffness in FibroScan® and >  1.75 m/s in Acoustic Radiation Force Impulse Imaging were considered ILS, patients with both measurements below the respective cut-off were ILS negative. Univariate analysis with receiver operating characteristic curve analysis and multivariate analysis were performed.

results78 patients (19.8%) had ILS. Of these, 28 patients developed complications despite treatment. SAWS correlated significantly with patients with ILS. Further significant correlations were emergency hospital admission, Alcohol Withdrawal Scale ≥  5, lower potassium, elevated bilirubin, increased Gamma-GT, thrombocytopenia, previous WS, and previous DT. In multivariate binary regression analysis, odds ratio for SAWS was 5.4 for emergency admission, 3.5 for previous DT and 2.2 for ILS, even if the significance level for the last parameter was missed.

conclusionsPatients with ILS have an increased risk of developing SAWS, as well as patients with emergency admission and previous DT among other markers. Treatment in an appropriately equipped facility is recommended for patients with this risk profile which can be measured easily by a general practitioner or in an emergency department.

Indexed as

Alcohol Withdrawal DeliriumAlcohol Withdrawal SeizuresLiverAdultAgedElasticity Imaging TechniquesEmergency Service, HospitalFemaleHumansMaleMiddle AgedProspective StudiesRisk Factors

Identifiers

PMID40106468
PMCPMC11922238

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.