Delirium tremens (DT) is a severe manifestation of alcohol withdrawal that can require inpatient management. The authors investigated whether acute kidney injury (AKI) among patients hospitalized with DT is associated with worse in-hospital outcomes and which patient-level factors are linked to AKI in this population.
This was a retrospective observational analysis using the National Inpatient Sample covering 2017 through 2022. Adult hospitalizations with a principal diagnosis of DT were identified using ICD-10 codes; AKI was identified as a secondary diagnosis using administrative coding. The study population, variable definitions, and covariates were derived from the sample and coding fields available in the database as summarized in the source abstract.
The predefined primary outcomes were the rate of endotracheal intubation, hospital length of stay, and all-cause in-hospital mortality. The investigators used multivariable regression to adjust for confounders. In addition, propensity-based methods — inverse probability of treatment weighting (IPTW) and augmented inverse probability weighting — were applied to test the robustness of associations between AKI and outcomes.
Among 267,375 hospitalizations with a principal diagnosis of delirium tremens, 11.26% had a secondary diagnosis of AKI.
Unadjusted comparisons between DT hospitalizations with and without AKI showed:
All unadjusted differences reported were statistically significant (P < 0.001).
After multivariable adjustment, AKI remained independently associated with worse hospital outcomes:
The direction and statistical significance of these associations persisted when analyzed using inverse probability of treatment weighting and augmented inverse probability weighting, supporting robustness to measured confounding.
In analyses identifying characteristics linked to AKI among DT admissions, AKI was associated with:
These factors were reported as associated with increased likelihood of AKI in the DT cohort; the abstract does not provide the numerical effect estimates for each factor.
In this large national sample of DT hospitalizations, AKI occurred in approximately one in nine admissions and was associated with substantially worse in-hospital outcomes, including higher rates of mechanical ventilation, longer length of stay, and a notably increased risk of mortality after adjustment. The authors conclude that AKI is common among patients hospitalized with DT and identifies a subgroup at higher in-hospital risk.
Clinically, these findings suggest the importance of early recognition and management of kidney injury in patients with severe alcohol withdrawal. Identification of patients with risk factors such as sepsis, obesity, higher comorbidity burden, male sex, and Black race may help target monitoring and supportive care to mitigate progression of AKI and associated complications.
The summary presented here is based on the abstract. The abstract reports study design, data source (National Inpatient Sample 2017–2022), cohort size, prevalence of AKI, unadjusted outcomes, adjusted effect estimates for primary outcomes, and factors associated with AKI. The abstract does not report several details, including:
These methodological and granular clinical details were not reported in the abstract and would require the full text for confirmation.