Clinical Characteristics, Severity, and Treatment Outcomes of Alcohol Withdrawal Syndrome in Patients With Alcohol-Associated Liver Disease: A Comparative Observational Study.

Abstract

Background: Aim: To evaluate and compare the clinical characteristics and treatment outcomes of alcohol withdrawal syndrome in patients with and without liver disease. Materials and Methods: This hospital-based observational comparative study was conducted in the Department of General Medicine, ESIC Medical College and Hospital, MIA, Desula, Alwar, Rajasthan. A total of 300 patients diagnosed with alcohol withdrawal syndrome were enrolled and divided into two groups: patients with liver disease [LIV(+)] and patients without liver disease [LIV(-)], with 150 patients in each group. Diagnosis of AWS was based on DSM-5 criteria and severity assessment was performed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale. Detailed demographic, clinical, and laboratory parameters were recorded. Treatment outcomes including duration of hospital stay, ICU admission, withdrawal seizures, delirium tremens, ventilatory support, and mortality were assessed. Statistical analysis was performed using SPSS software, and p<0.05 was considered statistically significant. Results: The mean age of patients with liver disease was significantly higher compared to patients without liver disease (54.2 ± 11.8 years vs. 49.6 ± 13.4 years; p<0.05). Severe withdrawal manifestations including hallucinations, delirium tremens, and withdrawal seizures were significantly more common in the LIV(+) group. The mean peak CIWA-Ar score was significantly higher among patients with liver disease (18.2 ± 6.1 vs. 13.5 ± 5.2; p<0.001). Laboratory abnormalities such as elevated bilirubin, transaminases, hypoalbuminemia, thrombocytopenia, and prolonged coagulation profile were significantly associated with liver disease. Patients with liver disease had longer hospital stay (7.8 ± 3.4 days vs. 4.6 ± 2.1 days; p<0.001), increased ICU admission (25.7% vs. 10.0%), higher requirement for mechanical ventilation (10.0% vs. 2.9%), and greater mortality (7.9% vs. 2.1%). Conclusion: Alcohol withdrawal syndrome in patients with liver disease is associated with significantly increased clinical severity, prolonged hospitalization, higher ICU requirement, and increased mortality compared to patients without liver disease. Liver disease should be considered an important predictor of adverse outcomes in AWS. Early identification, close monitoring, individualized benzodiazepine therapy, and aggressive supportive management are essential to improve prognosis in this high-risk population.