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Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures.

Journal article
Authors Ulf Berggren
Claudia Fahlke
Kristina Berglund
Kaj Blennow
Henrik Zetterberg
Jan Balldin
Published in Alcohol and alcoholism (Oxford, Oxfordshire)
Volume 44
Issue 4
Pages 382-6
ISSN 1464-3502
Publication year 2009
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Department of Psychology
Pages 382-6
Language en
Links dx.doi.org/10.1093/alcalc/agp012
Keywords Adult, Aged, Alcohol Withdrawal Delirium, epidemiology, etiology, Blood Cell Count, Central Nervous System Depressants, adverse effects, Ethanol, adverse effects, Female, Hemoglobins, metabolism, Humans, Leukocyte Count, Male, Middle Aged, Retrospective Studies, Risk Factors, Seizures, epidemiology, etiology, Sex Factors, Substance Withdrawal Syndrome, epidemiology, etiology, Thrombocytopenia, epidemiology, etiology, Young Adult
Subject categories Psychiatry, Psychology

Abstract

AIMS: In several studies, possible risk factors/predictors for severe alcohol withdrawal syndrome (AWS), i.e. delirium tremens (DT) and/or seizures, have been investigated. We have recently observed that low blood platelet count could be such a risk factor/predictor. We therefore investigated whether such an association could be found using a large number of alcohol-dependent individuals (n = 334). METHODS: This study is a retrospectively conducted cohort study based on data from female and male patients (>20 years of age), consecutively admitted to an alcohol treatment unit. The individuals had to fulfil the discharge diagnoses alcohol dependence and alcohol withdrawal syndrome according to DSM-IV. RESULTS: During the treatment period, 3% of the patients developed DT, 2% seizures and none had co-occurrence of both conditions. Among those with DT, a higher proportion had thrombocytopenia. Those with seizures had lower blood platelet count and a higher proportion of them had thrombocytopenia. The sensitivity and specificity of thrombocytopenia for the development of DT during the treatment period was 70% and 69%, respectively. The positive predictive value (PPV) was 6% and the negative predictive value (NPV) was 99%. For the development of seizures, the figure for sensitivity was 75% and for specificity 69%. The figures for PPV and NPV were similar as those for the development of DT. CONCLUSIONS: Thrombocytopenia is more frequent in patients who develop severe AWS (DT or seizures). The findings, including the high NPV of thrombocytopenia, must be interpreted with caution due to the small number of patients who developed AWS. Further studies replicating the present finding are therefore needed before the clinical usefulness can be considered.

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