Hemodynamic Disorders in Alcohol Withdrawal Syndrome

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INTRODUCTION: The introduction of the study is determined by a high prevalence of alcoholism and a high incidence of complications from the cardiovascular system.

AIM: To study the features of hemodynamics in patients with uncomplicated alcohol withdrawal syndrome (AWS) and in those with alcohol withdrawal delirium (delirium tremens).

MATERIALS AND METHODS: The study enrolled 116 men, 58 of them with uncomplicated AWS, 78 with AWS and delirium. Basic hemodynamic parameters were studied: heart rate (HR), blood pressure (BP), and integral parameters — cardiac index (CI), total peripheral resistance (TPR), shock index (SI). Comparisons between the groups and correlation analysis were conducted to find relationships between hemodynamic parameters and clinical data.

RESULTS: In patients with alcoholic delirium, hemodynamic parameters were statistically significantly higher than in patients with uncomplicated AWS: HR (р = 0.003), systolic BP (р = 0.02) and diastolic BP (р = 0.04), while no statistically significant differences in the integral parameters (CI, TPR, SI) were found between the groups. In patients of both groups, CI linearly decreased with age (p < 0.0001). The same linearly CI decreased with increase in the duration of alcoholism (p = 0.02). With an increase in the amount of consumed alcohol during the binge period, a linear growth of CI was observed in withdrawal state (p = 0.001). The value of TPR increased with age (p = 0.005). Only in patients with delirium tremens, there was an inverse relationship between SI and partial tension of carbon dioxide in venous blood (r = -0.4; p = 0.014). Besides, only in patients with delirium tremens, by the 7th day of withdrawal, a direct relationship was established between the cardiac index and blood potassium level (r = 0.36; p = 0.03).

CONCLUSIONS: There was no significant difference between hemodynamic parameters in uncomplicated AWS and in delirium tremens. CI in patients with uncomplicated AWS and in those with DT decreased with age and with increase in the alcohol load. The vessel tone was inversely proportional to CI throughout the entire period of observation. With the development of delirium, a correlation was noted between a decrease in the level of energy metabolism and the probability for decompensation of systemic circulation. At the stage of reduction of delirium tremens, a correlation was noted between CI and the blood potassium level that reflected the exhaustion of the cardiovascular system and reduction of its compensatory capacities.

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作者简介

Sergey Utkin

Moscow Research and Practical Centre for Narcology; N. V. Sklifosovskiy Institute of Clinical Medicine at the I. M. Sechenov First Moscow State Medical University (Sechenov University)

编辑信件的主要联系方式.
Email: utkin_s_i_1@staff.sechenov.ru
ORCID iD: 0000-0001-7867-1830
SPIN 代码: 5153-6237

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

Oleg Buzik

Moscow Research and Practical Centre for Narcology

Email: buzic58@bk.ru
ORCID iD: 0000-0001-9470-6781
SPIN 代码: 7140-5795

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

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2. Fig. 1. Dynamics of changes in cardiac index in delirium tremens (DT) and uncomplicated alcohol withdrawal syndrome (AWS).

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3. Fig. 2. Dynamics of changes in total peripheral resistance (TPR) in delirium tremens (DT) and uncomplicated alcohol withdrawal syndrome (AWS).

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4. Fig. 3. Dynamics of changes in shock index (SI) in delirium tremens (DT) and uncomplicated alcohol withdrawal syndrome (AWS).

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5. Fig. 4. Relationship between parameters of shock index and partial tension of carbon dioxide in venous blood (PvСО2) in patients with delirium.

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6. Fig. 5. Relationship between parameters of shock index and partial tension of carbon dioxide in venous blood (PvСО2) in patients with delirium at PvСО2 below 42 mm Hg.

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