AIM:To examine the association between weekend discharge and post-transplant alcohol relapse, graft survival, and acute rejection in liver transplant recipients with alcohol-associated liver disease (ALD). METHODS:Single-center retrospective cohort study of 362 adult ALD liver transplant recipients (2016-2023). Weekend discharge was compared with weekday discharge. The primary outcome was alcohol relapse, analyzed using competing-risks methods with death as a competing event; secondary outcomes were graft survival and acute cellular rejection (ACR). RESULTS:Sixty one (16.9%) had weekend discharge. Weekend recipients were older (median 59 vs. 53 years; P = .01); other baseline characteristics were comparable. Three-year cumulative relapse incidence was 13.7% vs. 21.1% (P = .36). Weekend discharge was not independently associated with relapse (adjusted HR 0.89, 95% CI 0.46-1.71; P = .72); shorter pre-transplant abstinence was the only independent predictor (adjusted HR 0.99/month; P = .03). Although unadjusted 3-year graft survival was lower in the weekend group (76.6% vs. 89.6%; P = .03), this difference was not retained after adjustment (adjusted HR 1.50, 95% CI 0.80-2.83; P = .21). Unadjusted ACR incidence was comparable across all horizons (P ≥ .25). CONCLUSIONS:Among ALD liver transplant recipients managed with standardized discharge education and protocolized relapse surveillance, weekend discharge was not independently associated with alcohol relapse or graft survival after adjustment, and unadjusted ACR incidence did not differ between discharge groups. However, both adjusted estimates remain compatible with clinically meaningful benefit or harm, and these findings therefore represent a failure to detect an association rather than evidence of equivalence. Protocolized discharge care may mitigate the impact of reduced weekend staffing, although discharge timing itself may simply exert little influence on these outcomes. Multicenter studies are needed to assess generalizability.
BACKGROUND:Mutual help organizations (MHOs) for alcohol and substance use disorders are peer-based programs offering recovery-specific social support. A wide-ranging, diverse body of published MHO literature examines their clinical and public health utility. We conducted a meta-review ("overview of reviews") to synthesize this evidence and identify trends, limitations, and gaps across existing syntheses. METHODS:We searched five electronic databases (August 2023) using tailored search strings to identify reviews of MHOs. We coded review characteristics and quality ratings (A Measurement Tool to Assess Systematic Reviews 2) in duplicate and quantified overlap of primary studies [corrected covered area (CCA)]. RESULTS:Twenty-five reviews (one scoping, 15 systematic, and 9 meta-analyses) were included, encompassing 163 111 participants and 645 unique primary studies, with minimal overlap (CCA = 1.76%). Overall methodological quality was mixed. Most reviews focused on 12-step MHOs/12-step facilitation (20; 80%), particularly Alcoholics Anonymous (13; 52%). Few focused on adolescents (2), individuals with co-occurring disorders (3), or Indigenous populations (1). Over half (56%) did not report race/ethnicity; those that did reported ranges from 0% to 81% White (M = 58.4%). Sex/gender was reported in 48% (M = 71.5% male). All meta-analyses examined alcohol and/or other substance use outcomes; some also assessed related outcomes, e.g. social connection, physical/mental health, education/employment, criminal justice involvement, and cost-effectiveness/healthcare utilization. CONCLUSIONS:Despite numerous reviews, the synthesis literature is limited in methodological rigor, with a narrow focus on 12-step MHOs. Reporting of outcomes and demographic data is inconsistent, but improves over time. Given variation in individuals' recovery pathways, future syntheses should examine newer, non-12-step MHOs, distinct populations, and outcomes beyond alcohol/substance use behaviors.
INTRODUCTION:Alcohol intoxicated patients frequently present to emergency departments and often require assessment of withdrawal risk. While Predictor of Alcohol Withdrawal Severity Score effectively predicts severe withdrawal outcomes, its reliance on patient history can be a limitation in the emergency department. Initial serum ethanol concentrations in these patients are sometimes used to make disposition decisions despite a lack of evidence to support their association with complicated alcohol withdrawal risk. METHODS:A retrospective cohort analysis was performed on 61 279 Veterans Health Administration emergency department visits from 2010 to 2019 which resulted in hospital admission after an initial serum ethanol concentration of >50 mg/dl was measured. Patients who developed withdrawal during their Emergency Department (ED) stay were excluded. Variables included serum ethanol concentration, demographics, and prior withdrawal history. Outcomes were International Classification of Diseases (ICD)-coded alcohol withdrawal and delirium tremens (DTs). Statistical analyses comprised Analysis of Variance (ANOVA), risk ratios, and logistic regression adjusting for prior withdrawal history. RESULTS:Among the cohort, 15% experienced alcohol withdrawal, and 1% developed DTs. While initial serum ethanol levels were higher in those with withdrawal (213 vs 203 mg/dl), the correlation was modest, and weaker than serum aspartate aminotransferase/alanine aminotransferase. Prior withdrawal history was a stronger predictor (Relative Risk [RR] 3.72 for withdrawal; RR 5.52 for DTs). After logistic regression adjusting for prior withdrawal history, serum ethanol concentration ≥400 mg/dl was not a useful predictor of withdrawal or DT risk (Odds Ratio [OR] ~ 1.00). CONCLUSIONS:Initial serum ethanol concentration offers a measurable but limited predictive value for complicated alcohol withdrawal risk, and no utility when a reliable prior history is available.
BACKGROUND:Prospective studies are lacking on the associations between job stressors and alcohol-related outcomes in the working population. The objectives were to explore the prospective associations of these exposures, including changes in exposure, with three alcohol-related outcomes. METHODS:The study relied on the prospective data of the national French ESPS survey (Health, health care and insurance survey) collected among a sample of 2080 workers in 2010 and 2014. Ten job stressors, derived from the job strain and effort-reward imbalance models, in 2010 (baseline) and changes in these exposures between 2010 and 2014 were studied. The incidence of three alcohol-related outcomes in 2014 (follow-up) was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) among the study sample of workers free of these outcomes at baseline: intermediate/heavy drinking, binge drinking, and alcohol misuse. Robust Poisson regression models were performed to study the exposure-outcome associations before and after adjustment for covariates. Gender-related interactions were tested. RESULTS:Job insecurity at baseline predicted the incidence of binge drinking at follow-up [incidence rate ratio (IRR) = 2.18; 95% confidence interval (CI): 1.33-3.58], and persistent job insecurity in both 2010 and 2014 displayed the strongest association with the incidence of binge drinking (IRR = 2.74; 95% CI: 1.36-5.54). Redundancy plan at baseline was borderline significant as a predictive factor of the incidence of binge drinking. Low freedom at work at baseline predicted the incidence of alcohol misuse among women. CONCLUSIONS:Job stressors, particularly those related to employment uncertainty, predicted the incidence of alcohol-related outcomes, especially binge drinking. Job stressors, including persistent exposures, may warrant more attention for preventing alcohol-related outcomes.
AIMS:This study aimed to explore the factors influencing the transition from non-psychiatric medical institutions (NPMIs) (e.g. internal medicine or emergency departments) to specialized treatment from the perspectives of people with alcohol use disorder (AUD) and their families. METHOD:A qualitative study using semi-structured in-depth interviews with people with AUD and their families who had visited NPMIs. Participants were recruited through purposive sampling from self-help groups. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS:Interviews were conducted from July to October 2024 with 13 people with AUD and eight family members. Four themes were identified: (1) Lack of knowledge and stigma among people with AUD and families affects early AUD support; (2) Situations where interactions with non-specialists do not lead to AUD support; (3) Collaboration between families and healthcare providers helped enable access to specialized treatment; and (4) Expectations for AUD support in NPMIs based on an empathetic approach. CONCLUSIONS:To improve the transition of people with AUD from NPMIs to specialized treatment, healthcare providers should recognize the risks of offering inappropriate reassurance or general advice such as 'cut down' or 'have alcohol-free days,' which may reinforce existing harmful behaviours. Providers should understand how people with AUD and their families interpret medical interactions, work to enhance collaboration with families, cultivate a non-stigmatizing approach, and proactively share knowledge about alcohol-related harm and self-help group resources.
AIMS:This meta-analysis synthesizes empirical research on the association between alcohol consumption, operationalized as both volume and frequency, and Five Factor Model of Personality Traits. METHODS:A systematic literature search was conducted on June 18, 2025, in PsycINFO and PubMed. The search strategy employed the following terms: tiab("big 5" OR "big five" OR "5 factor" OR "five factor") AND tiab(alcohol). Studies meeting predefined inclusion criteria were included in both a narrative synthesis and a quantitative meta-analysis. RESULTS:Six studies met the inclusion criteria and were included. The results showed that the FFM trait extraversion demonstrated a small but positive association with alcohol consumption, and the trait conscientiousness showed a stable inverse relationship with alcohol consumption. In contrast, findings for the FFM traits agreeableness, openness to experience, and neuroticism were heterogeneous and did not reveal consistent patterns of association. Overall, the associations between FFM traits and alcohol consumption in adolescence were modest and generally weaker than those reported in adult populations and underscore the importance of adopting a developmental perspective when interpreting the results. CONCLUSION:This meta-analysis highlights contradictory findings regarding the associations between adolescent alcohol consumption and the FFM of personality traits. While extraversion and conscientiousness appear to be modestly related to alcohol use, evidence concerning agreeableness, openness, and neuroticism remains inconclusive. Accordingly, future research should investigate potential moderating factors, including peer influence and family environment, to further clarify how personality traits interact with contextual influences in the development of alcohol consumption during adolescence.
INTRODUCTION:The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) definition of recovery from alcohol use disorder (AUD) expanded from an abstinence-based model to encompass remission from AUD symptoms and cessation from heavy drinking. However, many neuroimaging studies continue to use abstinence-based definitions of recovery. Many neuroimaging studies also report limited sample demographic information and diverse participants remain underrepresented in neuroimaging research. The aims of this systematic review were to: (i) update a review by Parvaz et al. (2022) on the topic of structural changes in the prefrontal cortex, (ii) apply the NIAAA's updated definition of recovery to studies in the original review and newly identified studies, and (iii) report demographic information from all included studies. MATERIALS AND METHODS:The original review was extended by searching PubMed and PsycInfo for articles published between May 2021 and June 2025. Demographic reporting practices were reviewed and the Newcastle-Ottawa Quality Assessment Scale was used to assess bias in all included articles. RESULTS:There was one newly identified study which reported cessation from heavy drinking. However, the 19 original studies were abstinence-based and did not use the updated NIAAA definition of recovery. Demographic information in the 20 included studies was largely limited to age, sex assigned at birth, and educational attainment. Reporting on additional demographic information was scarce. CONCLUSIONS:Future neuroimaging studies should examine duration of alcohol use disorder symptom remission and cessation of heavy drinking as outcomes. Moreover, studies should include additional demographic information. These efforts would align with national guidelines and advance clinical science.
BACKGROUND:The pharmacological management of alcohol use disorder (AUD) currently includes six medications approved by different regulatory agencies worldwide: acamprosate (ACM), naltrexone (NTX), nalmefene (NMF), disulfiram (DF), baclofen, and sodium oxybate (SO). Their optimal use should be aligned with the main aims of treatment, namely reduction of alcohol consumption and maintenance of complete abstinence. OBJECTIVES:This brief review summarizes the role of these six approved medications in AUD treatment and proposes practical treatment algorithms according to treatment goals, mechanisms of action, and clinically relevant outcomes. METHODS:A focused narrative review of the literature was conducted, prioritizing meta-analyses, systematic reviews, randomized controlled trials, and relevant regulatory documents. Evidence on efficacy, safety, tolerability, and clinical applicability was interpreted pragmatically to support first-, second-, and third-line pharmacological strategies. RESULTS:For reducing alcohol intake, NMF or NTX are proposed as first-line pharmacotherapies, with baclofen considered as a second-line option when these agents are partially effective or ineffective. For maintaining abstinence, ACM is proposed as a first-line strategy. In selected clinical settings, including severe AUD, protracted alcohol withdrawal syndrome, high motivation for aversive treatment, or liver disease, SO, baclofen, DF, or NTX may serve as second-line options. Combined pharmacotherapy may be considered in highly adherent patients, whereas off-label drugs remain third-line options for refractory cases. CONCLUSIONS:Improved knowledge of the efficacy, safety, and tolerability of the six approved medications may support more appropriate, individualized, and goal-oriented pharmacological management of patients with AUD. The proposed algorithms are intended as pragmatic tools to aid clinical decision-making rather than as formal guidelines.
BACKGROUND:Patient-reported symptoms following COVID-19 exposure have been understudied in cirrhosis. This study evaluated type, severity, and persistence of symptoms along with impact on quality of life (QOL) post-SARS-CoV-2 infection in a cohort with and without alcohol-related cirrhosis. METHODS:Patients with cirrhosis receiving care in hepatology clinics at three institutions were surveyed for symptoms and liver disease QOL (LDQOL) using standardized instruments following SARS-CoV-2 infection. Acute (<30 days), post-acute (≥30 days since onset), and Long COVID (≥3 months) symptoms were compared by cirrhosis etiology and decompensated status. Associations between severe COVID-19 symptoms and LDQOL were examined using multivariable models. RESULTS:156 patients with prior COVID-19 exposure had a median age of 66.5 years; 18% were female; 43% had alcohol-related liver disease (ALD); and 42% decompensated cirrhosis. Among 208 surveys conducted, the median (Q1, Q3) number of symptoms reported was 6 (3, 10), with 66% reporting at least one severe/very severe symptom and 21% had Long COVID. There were no significant differences in symptoms by cirrhosis etiology or decompensation except those with ALD had higher post-acute symptoms compared to non-ALD (RR 2.17, P = .04). Moreover, the total number of severe symptoms was inversely associated with LDQOL. For each additional severe symptom reported, LDQOL decreased by 1.12 points after adjusting for age, sex, ALD, decompensated cirrhosis, and MELD-Na score (95% CI -1.70 to -0.53, P = .001). CONCLUSIONS:Assessing severity and persistence of post-COVID-19 exposure symptoms can help clinicians address patient-reported QOL concerns, optimize cirrhosis management, and inform integrated care for ALD and AUD.
AIMS:The goal of this study was to determine the effect of administering arachidonic acid (ARA) with or without the yeast Saccharomyces cerevisiae, on voluntary ethanol consumption by mice. METHODS:Ethanol consumption was measured using a continuous access two-bottle choice experiment with water and 15% ethanol (vol/vol). Ethanol naïve C57BL/6J mice were orally inoculated with ARA (or acidic PBS as the control), S. cerevisiae, or both each evening for three evenings. Ethanol consumption and preference were measured on the following days. In additional experiments, male and female mice underwent chronic intermittent exposure to ethanol vapor. After a 2-week exposure protocol, these mice were given access to 15% ethanol (vol/vol) via a two-bottle choice and inoculated nightly with ARA and S. cerevisiae (or acidic PBS and mock as the control). RESULTS AND CONCLUSIONS:Administration of ARA initially reduced ethanol preference and consumption by ethanol naïve female mice but the effects waned. In contrast, administration of ARA together with a fungus had a sustained effect that reduced preference and consumption. The effects of ARA and fungi were statistically significantly different from ARA alone on Day 3 of ethanol access. Chronically exposed mice that showed low initial consumption of ethanol in the two-bottle choice maintained low consumption when administered ARA and S. cerevisiae. These findings support the future development of a therapeutic regimen utilizing ARA and yeast, or targeting eicosanoids, that could be developed as a supplement to current approaches to reduce ethanol consumption.
OBJECTIVE:Large administrative datasets enable investigation of rare outcomes, but accurate individual-level prediction remains challenging. Emerging evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), used to treat diabetes and obesity, may reduce alcohol craving and intake. We examined predictors of incident alcohol-related disorder (ARD) using inverse probability-weighted (IPW) machine learning models, focusing on GLP-1 RA use. METHODS:We conducted a retrospective cohort study using the MarketScan Multi-State Medicaid Database (N = 96 460). Type 2 diabetic adults aged 18-64 years with GLP-1 RA prescription coverage (2022-2023) and no ARD in 2022 were included. Baseline variables included demographics, social risk factors (Z-codes), comorbidities, insurance characteristics, and GLP-1 RA use. Propensity scores were used to derive stabilized IPW weights to adjust for confounding in GLP-1 RA exposure. An Extreme Gradient Boosting model with IPW was trained using a 70/30 train-test split with five-fold cross-validation and probability calibration. Performance was evaluated using Area Under the Receiver Operating Characteristics Curve (AUROC), recall, and precision. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). RESULTS:GLP-1 RAs were used by 21.7% of individuals; 2.1% (N = 2004) developed incident ARD. The model demonstrated modest discrimination (AUROC = 0.67). Recall and precision were 0.28 and 0.05, respectively. SHAP analysis ranked GLP-1 RA use as the sixth most influential predictor and showed an association with lower predicted ARD risk. CONCLUSION:Predicting rare outcomes remains difficult, particularly for identifying positive cases. Interpretable machine learning identified GLP-1 RA use as an important feature associated with lower predicted ARD risk, warranting further investigation.
AIMS:Preliminary evidence suggests that exposure to alcohol-related content in popular music is associated with drinking behaviour, especially amongst young people. Guided by Uses and Gratifications Theory, which posits that audiences select music to satisfy psychological and social needs, alcohol references, and specific audio features may co-occur as part of shared emotional and social experiences. This study assessed whether song audio features are associated with alcohol references in lyrics and whether they could support population-level surveillance of alcohol-related media exposure. METHODS:We analyzed 6110 Billboard Top 100 songs released between 1959 and 2020, extracting Spotify audio features for each track. Logistic regression models were used to examine associations between audio features and the presence of alcohol references in lyrics. RESULTS:Alcohol references were found in 16.1% of songs, with prevalence increasing significantly over time. Songs with higher danceability (OR = 1.35, P < .001), speechiness (OR = 1.39, P < .001), liveness (OR = 1.09, P = .021), positive valence (OR = 1.11, P = .041) and major mode (OR = 1.18, P = .042) more likely to contain alcohol references. Higher acousticness (OR = 0.82, P < .001) and instrumentalness (OR = 0.85, P = .015) were associated with lower odds. Loudness, tempo, and energy were not significantly associated. CONCLUSIONS:Audio features may help identify songs more likely to contain alcohol references in music and may have potential utility for monitoring alcohol-related messaging across large volumes of popular music. Such tools could complement broader public health efforts to reduce alcohol exposure, especially amongst young people.
BACKGROUND:Despite evidence-based pharmacological and behavioural interventions, alcohol use disorder (AUD) is associated with highly variable treatment outcomes. Functional magnetic resonance imaging (fMRI) may identify neural markers that predict treatment response, ultimately supporting a precision medicine approach to AUD. OBJECTIVES:This systematic review synthesized evidence on fMRI predictors of treatment outcomes in individuals with AUD, evaluated methodological consistency, and identified gaps to guide biomarker development. METHODS:A comprehensive search of PubMed/MEDLINE, Embase, and PsycINFO combined terms related to fMRI, AUD, and treatment outcomes. Eligible studies included participants with AUD receiving pharmacological, behavioural, or neuromodulatory interventions with fMRI measures collected before or early in treatment to predict clinical outcomes. Screening and extraction were conducted in duplicate using Covidence, and study quality was assessed with the Grading of Recommendations Assessment, Development, and Evaluation framework. RESULTS:Of 342 records, 15 studies met the inclusion criteria. Most used alcohol cue reactivity tasks (k = 11), with others using resting-state fMRI (k = 2), a monetary reward task (k = 1), or an alcohol-specific Go/No-Go task (k = 1). Pharmacological treatments were most common (k = 8), followed by behavioural therapies (k = 6) and one neuromodulation trial. Across paradigms, neural activity in the ventral striatum, orbitofrontal cortex, and anterior cingulate cortex commonly predicted outcomes. Greater prefrontal engagement predicted improvement, while heightened striatal cue reactivity predicted relapse. Resting-state findings suggested reduced reward- and stress-network connectivity corresponded with better outcomes. Across studies, however, considerable heterogeneity and inconsistency were present and sample sizes tended to be small. CONCLUSIONS:Evidence implicates frontostriatal and salience circuitry in predicting AUD treatment outcomes, but inconsistency and underpowered studies limit firm conclusions. Larger longitudinal studies are needed to robustly validate clinically useful biomarkers.
BACKGROUND:Motivational interviewing (MI) is a patient-centred, goal-oriented psychotherapy for alcohol use disorder (AUD) and numerous other conditions. While some language patterns have been linked to MI response, less is known about how broader linguistic features, sentiment, and engagement relate to post-intervention drinking. This study used natural language processing to examine these associations and clarify mechanisms through which MI for AUD exerts its effects. METHODS:Adults with AUD (N = 68) completed a single MI session with structured feedback and discussion of potential drinking changes. Speech transcripts were analysed for change-, emotion-, motivation-, substance-, and health-related words. Sentiment analysis assessed emotional polarity, and engagement was measured by total words spoken. Linear regression models tested associations between linguistic features and drinking outcomes, including drinks/week, percent heavy drinking days (%HDD), and percent drinking days (%DD). RESULTS:Participants showed significant reductions in drinks per week and %DD. Consistent with recent reviews of MI predictors, linguistic analyses found that greater use of change talk and health-related language was associated with more drinks per week at follow-up, whereas greater emotional talk and positive sentiment predicted fewer drinks per week. Health- and substance-related language predicted higher %HDD, while social motivation-related language predicted lower %DD. Term-frequency and multivariate analyses supported these patterns. CONCLUSIONS:Via natural language processing of MI speech, linguistic features such as motivational content and sentiment were linked to drinking outcomes. Findings demonstrate the potential of this approach as a scalable, data-driven complement to traditional coding systems, with applications for real-time feedback, clinician training, and personalized interventions.
AIMS:This study examines socioeconomic inequalities in alcohol-related emergency room (ER) visits in Catalonia, combining individual and area-level socioeconomic factors and comparing the results with the ones for all ER visits. METHODS:This population-based study retrospectively analyzed all 7 043 795 individuals aged 12 and older who received public healthcare in Catalonia in 2022 using sociodemographic, ER visits, and medical diagnoses data. Individuals were classified by individual-based and area-based socioeconomic levels (ISL and ASL, respectively). Binomial models assessed associations between ISL and ER visits, stratifying results by sex, age, and ASL. Alternative models were performed including interactions between both socioeconomic levels. RESULTS:In 2022, 22.2% of individuals visited ERs, of which 0.45% accounted for alcohol-related ER visits. Socioeconomic disparities were evident: individuals in the lowest ISL had an alcohol-related ER visit prevalence six times higher than the highest ISL. This pattern persisted across ASL, with more pronounced effects in wealthier regions. Age and sex influenced trends, with middle-aged males from low ISL groups showing the highest prevalence ratios. Interaction analysis revealed that the combined effect of low individual socioeconomic status and living in disadvantaged areas was smaller than would be expected if the effects were multiplicative. CONCLUSIONS:Significant socioeconomic disparities in ER visits exist in Catalonia, with lower socioeconomic groups, especially at the individual level, experiencing higher rates of alcohol-related ER visits. These findings underscore the need to address socioeconomic inequalities in healthcare access, particularly concerning alcohol-related health outcomes, highlighting the need to further research ISL and ASL interactions.
AIM:To examine whether individuals with alcohol-cocaine use disorder exhibit selective impairments in self-initiated verbal retrieval compared to individuals with alcohol use disorder alone. METHODS:Sixty outpatients meeting Diagnostic and Statistical Manual of Mental Disorders-Five Edition (DSM-5) criteria for Alcohol Use Disorder were classified into alcohol-only (n = 29) and alcohol-cocaine (n = 31) groups using the Structured Clinical Interview for DSM-5. Narrative delayed free recall was assessed in all participants (n = 60), while word-list learning and visual memory measures were available for 51 participants. Group differences were examined using general linear models controlling for age, estimated intellectual quotient, and benzodiazepine use. Urine toxicology screening was conducted prior to each assessment session to ensure recent abstinence from substances. RESULTS:After adjustment, the alcohol-cocaine group demonstrated significantly lower performance in delayed free recall of narrative material compared to the alcohol-only group (P = .010, η2p = .114). A similar but non-significant trend was observed for delayed word-list recall (P = .054). No group differences were found in cued recall, recognition performance, or visual memory measures. CONCLUSIONS:Alcohol-cocaine use disorder was associated with reduced efficiency in self-initiated verbal retrieval, while externally supported recall and visual memory remained relatively preserved. These findings suggest a selective impairment in strategic retrieval processes rather than a generalized memory deficit.
AIMS:While there are risk stratification tools for alcohol withdrawal syndrome (AWS), there are no well-established risk factors associated with phenobarbital escalation; the primary aim was to identify risk factors associated with needing phenobarbital dose escalation for AWS management. METHODS:This single-center, retrospective, cohort study evaluated adult patients with diagnosed AUD admitted to a surgical or medical intensive care unit of a large academic medical center within 24 hours of the initial phenobarbital dose for AWS management if admitted between 1 December 2021 and 1 December 2024. RESULTS:This study included 169 patients, 54 (32.0%) required dose escalation. The univariable analysis demonstrated that patients in the dose escalation group had a significantly higher percentage of preceding Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised scores (CIWA-Ar) scores ≥15, required more concomitant continuous infusion sedation, higher body mass indexes, and shorter times between phenobarbital administration and detectable blood alcohol levels, mechanical ventilation, and hospital admission. In a final multivariable logistic regression model, CIWA-Ar score ≥ 15 (OR: 2.41, (95% CI: 1.25-4.69; P = 0.008) was the only variable helping predict phenobarbital dose escalation. CONCLUSION:Based on our analysis, elevated CIWA-Ar scores may be the best predictor of phenobarbital dose escalation to treat severe AWS in the critically ill. These findings reinforce the importance of early intervention and dynamic clinical reassessment of phenobarbital dosing in the management of patients with AWS. Further prospective clinical trials are needed to assess risk factors in patients that require escalated treatment for AWS.
OBJECTIVES:Although NLRP3, sTREM2, and p-tau217 are important in Alzheimer's disease (AD), their relevance in alcohol-related brain damage (ARBD) is unclear. This study aimed to compare these biomarkers in patients with ARBD, non-alcoholic AD, and alcohol dependence without encephalopathy, and to examine their links to cognitive function. METHODS:This cross-sectional study included 45 ARBD patients, 41 non-alcoholic AD patients, and 39 alcohol-dependent patients without encephalopathy. We measured peripheral serum levels of NLRP3, sTREM2, and p-tau217 by enzyme-linked immunosorbent assay and assessed cognitive function using the Montreal Cognitive Assessment and Mini-Mental State Examination. Statistical analyses were performed to evaluate group differences and associations with ARBD. ARBD patients exhibited higher levels of inflammatory markers and more severe anxiety and depression than other groups. RESULTS:Serum sTREM2 was significantly highest in the ARBD group compared to both non-alcoholic AD and alcohol-dependent groups (P < .05). NLRP3 was also elevated in ARBD patients compared to the alcohol-dependent group (P = .005). No significant group differences were found for p-tau217. After adjusting for confounders, sTREM2 was significantly associated with cognitive, alcohol use, and mood scores, whereas NLRP3 was associated only with alcohol use and cognitive scores. Both sTREM2 and NLRP3 were independent predictors of ARBD. ROC analysis demonstrated that sTREM2 had the highest diagnostic accuracy for ARBD (AUC = 0.814), significantly outperforming NLRP3 (AUC = 0.671) and p-tau217 (AUC = 0.590). CONCLUSIONS:Serum sTREM2 and NLRP3 are promising peripheral biomarkers for ARBD. sTREM2, in particular, shows a strong association with clinical severity and demonstrates robust diagnostic potential, supporting its utility in the diagnosis and pathophysiological understanding of ARBD.
