Abstract
Background
The alcohol withdrawal syndrome is a group of symptoms and signs that usually arise within 24 -48 hours of abrupt alcohol cessation or significant reduction in consumption in alcohol dependent individuals. The most severe complication of alcohol withdrawal syndrome is alcohol withdrawal delirium (delirium tremens), which may be preceded or complicated by seizures. In recent years there is a growing interest in the role of serum homocysteine levels in chronic alcohol dependent patients undergoing withdrawal. A number of studies have shown that alcohol dependent patients have elevated serum homocysteine levels and that it can be considered to be a risk factor for severe withdrawal states. The purpose of this study was to evaluate the serum homocysteine levels in alcohol withdrawal syndromes.
Methodolgy
It was a retrospective cohort study of alcohol dependent patients (N=49) admitted with a diagnosis of delirium tremens (DT) (n=28) and simple alcohol withdrawal (SW) (n=21) as per the ICD-10 classification. A semi-structured pro-forma was used to gather information from the file records covering both socio-demographic, clinical and biochemical variables. The historical variables included proposed risk factors like amount of daily consumption of alcohol, duration of abstinence and past history of complicated withdrawal. The serum homocysteine, vitamin B12 and folate levels of all patients sent within 24 hours of admission were also collected. Comparisons between clinical and biochemical variables were made between the two groups using Chi-square test and Student’s T test.
Results
The mean age of patients of DT was 33.07 ± 8.24 years while that of patients with SW was 37.19 ±7.60 years. The mean duration of alcohol use in dependent pattern was 10.00 ±3.00 years in DT compared to 8.66 ±4.76 years in SW. The laboratory investigations revealed a mean serum homocysteine level of 21.09 ± 12.81 in patients presenting with DT as compared with 15.06 ± 6.17 in patients having SW and this difference was statistically significant (p<0.05). The serum folate levels differed significantly in the two groups with patients in DT having a lower mean value of 6.30 ± 3.67 as compared to patients with SW 10.23 ± 7.04. Patients with DT with withdrawal seizures (n=18) had statistically non significant rise in their mean homocysteine levels as compared to patients with DT without withdrawal seizures (n=10) [21.72±13.26 vs 19.96±12.58].
Conclusion
The results of this study highlight the potential role of homocysteine as a new biomarker to predict the severity of alcohol withdrawal syndromes. However there is need for further research to prove whether targeting homocysteine levels will be of benefit with respect to alcohol related disorders.