Relationship of Biochemical and Hematological Markers With Alcohol Withdrawal Severity

Background Alcohol withdrawal severity is widely assessed and objectified using the Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) scale. However, the subjective nature of this scale has led to several studies that scrutinized the relationship of various blood parameters to assess withdrawal severity. The aim of this study was to analyze the relationship of various laboratory biomarkers with the severity of alcohol withdrawal. Methods This was a retrospective study of 200 cases admitted to Rashid Hospital, UAE, with the diagnosis of alcohol withdrawal syndrome. Severity was assessed using CIWA-Ar. The average CIWA-Ar score was calculated and analyzed against creatine phosphokinase (CPK) on admission days one, two, and three using a correlation coefficient. Sixteen other blood markers were also analyzed, including hemoglobin, mean corpuscular volume, white blood cell (WBC), platelets, alanine transaminase, aspartate aminotransferase, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, gamma-glutamyl transferase, albumin, international normalized ratio, lactate dehydrogenase, sodium, potassium, magnesium, phosphate, and creatinine. Additionally, the duration of alcohol intake and the timing of the last alcohol intake were also examined in relation to the severity of alcohol withdrawal. Results Average CIWA-Ar exhibited a positive relationship with CPK on admission day one (r=0.2 (p=0.008)); day two (r= 0.25 (p=0.003)), and day three (r=0.42 (p<0.001)). WBC and AST showed a relatively rising trend with higher CIWA scores (average values, however, remain within the normal range). The results were not statistically significant (p>0.01). Serum potassium and magnesium levels followed a decreasing trend with rising CIWA (average values, however, remained within the normal range). These results were also not found to be statistically significant (p>0.1). Conclusion A high CPK level was associated with the severity of alcohol withdrawal syndrome (SAWS). Low serum potassium and magnesium and high WBC and AST can be associated with alcohol withdrawal severity. These routine laboratory tests can serve as objective indicators of severity in addition to using the CIWA-Ar score for AWS, enabling prompt management and prevention of complications.