Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 26:16:1569499.
doi: 10.3389/fpsyt.2025.1569499. eCollection 2025.

Alcohol withdrawal in patients with liver disease

Vugar Isazade  1   2 , Asmaa Yehia  3   4 , Umesh M Sharma  5 , Nan Zhang  6 , Terry Schneekloth  7 , Osama A Abulseoud  1   3
Affiliations

Alcohol withdrawal in patients with liver disease

Vugar Isazade et al. Front Psychiatry. .

Abstract

Objective: This study investigated and compared the clinical characteristics and treatment outcomes of alcohol withdrawal syndrome (AWS) in patients with and without liver diseases.

Method: We conducted a retrospective chart review of all hospital admissions that received the CIWA-Ar protocol at the Mayo Clinic Health System between June 2019 and June 2022.

Results: In this retrospective cohort study, we analyzed data for 1,586 hospitalizations for 811 liver disease [LIV(+)] patients and compared the results with 14,604 hospitalizations for 9,281 patients without liver disease [LIV(-)].Compared to the LIV(-) group, LIV(+) patients had more alcohol use disorder (94.3% vs. 58%, P = 0.003), longer hospital length of stay [Median (25th, 75th percentiles): 93 (51,173) vs. 69 (43,125) hours, P = 0.001], longer time to reach peak CIWA-Ar scores [Mean ± SD: 26.3 ± 35.9 vs. 2.4 ± 32.5 hours, P = 0.001], lower first 24 hours lorazepam dose equivalents [3.5 (1.5, 7) vs. 3.5 (1.5, 8) mg, P = 0.001], and higher mortality rates (16.8% vs. 5.8%, P = 0.001). Within the LIV (+) cohort, no sex difference was depicted except for longer time to reach peak CIWA in males (Mean ± SD: 28.5 ± 40.3 vs. 21.7 ± 24.5 hours, P = 0.014).

Conclusions: Our study highlights the higher mortality, hospital LOS, and ICU admissions in patients with liver cirrhosis and hepatic failure. We also recommend further controlled studies to examine the severity of AWS in hepatic patients, using other tools besides CIWA-Ar.

Keywords: CIWA-Ar; alcohol use disorder; alcohol withdrawal; liver disease; sex difference.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Levesque C, Sanger N, Edalati H, Sohi I, Shield KD, Sherk A, et al. . A systematic review of relative risks for the relationship between chronic alcohol use and the occurrence of disease. Alcohol Clin Exp Res (Hoboken). (2023) 47:1238–55. doi: 10.1111/acer.15121 - DOI - PubMed
    1. Seitz, Helmut K, Scherübl H. Alcohol use and gastrointestinal diseases. Visceral Med. (2020) 36:157–9. doi: 10.1159/000507643 - DOI - PMC - PubMed
    1. Chen G, Haber PS. Gastrointestinal Disorders Related to Alcohol and Other Drug Use, in Textbook of Addiction Treatment: International Perspectives. el-Guebaly N, Carrà G, Galanter M, Baldacchino AM, editors. Cham: Springer International Publishing; (2021) p. 1077–97.
    1. Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. . The epidemiology of cirrhosis in the United States: A population-based study. J Clin Gastroenterol. (2015) 49:690–6. doi: 10.1097/MCG.0000000000000208 - DOI - PubMed
    1. Argemi J, Ventura-Cots M, Rachakonda V, Bataller R. Alcoholic-related liver disease: pathogenesis, management and future therapeutic developments. Rev Esp Enferm Dig. (2020) 112:869–78. doi: 10.17235/reed.2020.7242/2020 - DOI - PubMed

LinkOut - more resources