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array:23 [ "pii" => "S2254887417300796" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.05.003" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "1403" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:381-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 11 "formatos" => array:2 [ "HTML" => 5 "PDF" => 6 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256517301315" "issn" => "00142565" "doi" => "10.1016/j.rce.2017.05.002" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "1403" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:381-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 56 "formatos" => array:2 [ "HTML" => 36 "PDF" => 20 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "386" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Monte-Secades, M. Blanco-Soto, J.A. Díaz-Peromingo, A. Sanvisens-Bergé, M.C. Martín-González, A. Barbosa, B. Rosón-Hernández, M.A. Tejero-Delgado, R. Puerta-Louro, R. Rabuñal-Rey" "autores" => array:11 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Monte-Secades" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Blanco-Soto" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Díaz-Peromingo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Sanvisens-Bergé" ] 4 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín-González" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Barbosa" ] 6 => array:2 [ "nombre" => "B." "apellidos" => "Rosón-Hernández" ] 7 => array:2 [ "nombre" => "M.A." "apellidos" => "Tejero-Delgado" ] 8 => array:2 [ "nombre" => "R." "apellidos" => "Puerta-Louro" ] 9 => array:2 [ "nombre" => "R." "apellidos" => "Rabuñal-Rey" ] 10 => array:1 [ "colaborador" => "Grupo de Trabajo Alcohol y Alcoholismo, Sociedad Española de Medicina Interna" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887417300796" "doi" => "10.1016/j.rceng.2017.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417300796?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517301315?idApp=WRCEE" "url" => "/00142565/0000021700000007/v1_201709280106/S0014256517301315/v1_201709280106/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887417300942" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.06.001" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "1412" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:387-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Incidence of cancer in outpatients with chronic obstructive pulmonary disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "387" "paginaFinal" => "393" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de cáncer en pacientes ambulatorios con enfermedad pulmonar obstructiva crónica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1254 "Ancho" => 1663 "Tamanyo" => 76215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative probability of being cancer free for patients with chronic obstructive pulmonary disease.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">*Age of the patient with chronic obstructive pulmonary disease at the time of cancer diagnosis. Dashed line: GOLD III–IV. Continuous line: GOLD I–II<span class="elsevierStyleSmallCaps">.</span> Log rank test, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.072.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Figueira Gonçalves, R. Dorta Sánchez, L.I. Pérez Méndez, L. Pérez Negrín, I. García-Talavera, A. Pérez Rodríguez, D. Díaz Pérez, P. Viña Manrique, C. Guzmán Sáenz" "autores" => array:9 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Figueira Gonçalves" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Dorta Sánchez" ] 2 => array:2 [ "nombre" => "L.I." "apellidos" => "Pérez Méndez" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Pérez Negrín" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "García-Talavera" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Pérez Rodríguez" ] 6 => array:2 [ "nombre" => "D." "apellidos" => "Díaz Pérez" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Viña Manrique" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Guzmán Sáenz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517301546" "doi" => "10.1016/j.rce.2017.06.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517301546?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417300942?idApp=WRCEE" "url" => "/22548874/0000021700000007/v1_201709280051/S2254887417300942/v1_201709280051/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "386" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Monte-Secades, M. Blanco-Soto, J.A. Díaz-Peromingo, A. Sanvisens-Bergé, M.C. Martín-González, A. Barbosa, B. Rosón-Hernández, M.A. Tejero-Delgado, R. Puerta-Louro, R. Rabuñal-Rey" "autores" => array:11 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Monte-Secades" "email" => array:1 [ 0 => "rafael.monte.secades@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Blanco-Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.A." "apellidos" => "Díaz-Peromingo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Sanvisens-Bergé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M.C." "apellidos" => "Martín-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Barbosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "B." "apellidos" => "Rosón-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "M.A." "apellidos" => "Tejero-Delgado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "R." "apellidos" => "Puerta-Louro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "R." "apellidos" => "Rabuñal-Rey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 10 => array:1 [ "colaborador" => "Grupo de Trabajo Alcohol y Alcoholismo, Sociedad Española de Medicina Interna" ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medicina Interna, Complejo Hospitalario Universitario, Santiago de Compostela, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitari Germans Trías i Pujol, Badalona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitario de Canarias, San Cristóbal de la Laguna, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitario, Salamanca, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitari Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Medicina Interna, Hospital Cabueñes, Gijón, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Medicina Interna, Hospital POVISA, Vigo, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spain has one of the highest rates of alcohol consumption per inhabitant in Europe: 11.2<span class="elsevierStyleHsp" style=""></span>l of pure alcohol per inhabitant per year, according to 2010 data from the World Health Organization.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A 12% rate of alcohol abuse has been recorded in an unselected population hospitalized in Spanish internal medicine departments, as well as a 6% rate of active alcohol dependence or in remission.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Only 1% of excessive drinkers have dependence. Of these, some develop alcohol withdrawal syndrome (AWS) of variable intensity when they stop drinking. There are numerous factors that likely influence this variability: genetic, epidemiological, clinical, sociodemographic, etc.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> Studies have indicated that the course of previous AWS episodes is the most reliable predictor of the progression of subsequent episodes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, the involvement of other comorbidities is unclear, as are the clinical or analytical factors associated with the most severe forms.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7</span></a> Moreover, the influence of sociodemographic factors on the long-term success of alcohol detoxification treatment has been assessed,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,8</span></a> but their influence on the clinical course of the AWS itself is unknown.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study is to analyze the influence of epidemiological and sociodemographic factors on the development of complicated AWS at hospital admission.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a multicenter, observational, prospective registry of patients with AWS, hospitalized consecutively in 12 Spanish internal medicine departments, from January 1, 2013 to December 31, 2014. The diagnosis of AWS and <span class="elsevierStyleItalic">delirium tremens</span> (DT) was established according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The study was approved by the ethics committees of all participating centers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We recorded sociodemographic, epidemiological, clinical and progression data in a database created for this purpose. We defined the pattern of regular alcohol abuse as the intake of constant daily quantities. The pattern of irregular alcohol abuse was defined as the intake of variable quantities, in peaks and valleys, over the course of days or weeks, for the 6 months prior to admission. Complicated alcohol withdrawal was defined as that which progressed with seizures or DT.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a descriptive study of the variables. To identify the predictors, we compared the means using Student's <span class="elsevierStyleItalic">t</span>-test and/or the Mann–Whitney <span class="elsevierStyleItalic">U</span> test after determining the normality and homogeneity of the variances. For the qualitative variables, we used the chi-squared test and Fisher's exact test when the cells contained values less than 5. We considered the level of statistical significance to be less than 0.05. We performed a logistic regression analysis to study the degree of association between the various factors and complicated AWS. We calculated the adjusted odds ratio values and their respective confidence intervals. The statistical analysis was conducted with the SPSS<span class="elsevierStyleSup">®</span> 15 statistics software package.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">We studied 228 episodes of hospitalization with AWS in 219 patients. The mean age was 54.4 years (SD, 11.5), and most of the participants (207, 90.8%) were men. AWS was the cause for hospitalization in 91 cases (39.9%), and 137 (60.1%) were hospitalized for other reasons but developed AWS during their stay. Seizures were recorded in 62 cases (27.1%), which were generalized in 53 (85.4%) cases, partial secondarily generalized in 7 (11.3%) cases and partial in 2 cases (3.2%). Seventy-four (32.4%) episodes progressed with DT. The mean Charlson index was 2 (SD, 1.8). Fifty-two (22.8%) patients were admitted to the intensive care unit, and the mean hospital stay was 15.6 days (SD, 27.8). The most common treatment regimen was fixed plus rescue dosage (71%), followed by fixed dosage (25%). Some 89.9% of the patients were treated with benzodiazepines, 42.9% with neuroleptics, 22.8% with clomethiazole and 14.4% with propofol. There were 5 deaths (2.1%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The daily alcohol intake was 173.3<span class="elsevierStyleHsp" style=""></span>g (SD, 120.9) or 17.8 standard drink units (SD, 21.4), with a mean duration of alcohol consumption of 28.7 years (SD, 13.5) and of dependence of 16.6 years (SD, 11.3). Wine was the most common beverage in the patients who consumed a single type of alcohol, with 64 cases (28%), followed by beer with 33 (14.4%) cases and spirits with 18 (7.8%). Multiple consumption of alcoholic beverages was recorded in 111 patients (48.6%). Of these, the most common combination was wine and beer (29.7%), followed by wine, beer and spirits (25.2%). A total of 72 patients (31.5%) had undergone failed detoxification programs, and 71 (31.1%) patients had previously experienced AWS with hospitalization. During the 12 months prior to the index admission, hospital emergency department visits for alcohol consumption were recorded for 62 patients (27.1%). The pattern of alcohol abuse was documented in 219 cases, of which 189 were regular (82.8%) and 30 were irregular (13.1%). One hundred and fifty patients consumed tobacco (65.7%), 11 (4.8%) consumed cannabis, 12 (5.2%) consumed cocaine, 7 (3%) consumed opioids, and 3 (1.3%) consumed synthetic drugs.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We recorded the marital status in 216 cases; of these, 83 (38.4%) were married or lived with a partner, 47 (20.4%) were separated, 78 (36.1%) were single, and 8 (3.4%) were widowers. Some 45.6% of the patients had children. At admission, 51 patients (22.3%) were employed, 81 (35.5%) were unemployed, and 85 were retired (37.2%). The marital status of 13 (5.7%) patients was unknown. The education level was determined in 194 patients: 23 (11.8%) had no formal education, 110 (56.7%) had primary education, 55 (28.3%) had secondary (high school diploma or equivalent or professional training), and 6 had university education (3.1%).</p><p id="par0050" class="elsevierStylePara elsevierViewall">We identified 110 episodes of complicated AWS. The epidemiological characteristics regarding alcohol consumption in this group compared with those of uncomplicated AWS (118 cases) are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The patients with complicated AWS had a tendency toward greater alcohol consumption (in terms of volume) and a higher number of previous hospitalizations for AWS and hospital emergency department visits. The concomitant consumption of cocaine and drug abuse other than alcohol (cannabis, opioids, synthetic drugs or cocaine) was associated with a greater risk of complicated AWS, as was hospitalization prompted by AWS. There were no differences in terms of the type of alcoholic beverage, the years of dependence or the pattern of intake.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The demographic characteristics of both groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The patients with complicated AWS were younger, but there were no differences in terms of sex, size of the hospital of origin or the patients’ population setting. We also observed no associations with marital status or employment status. However, the patients with a lower education level (illiterate or primary studies) had a greater chance of presenting seizures or DT.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The multivariate analysis included the variables age, sex, education level, employment status, marital status, years of consumption, grams of alcohol consumed daily, number of previous AWS episodes, number of alcohol-related emergency department visits, Charlson index, cocaine consumption, consumption of a drug other than alcohol and the reason for hospitalization. The independent variables related to the risk of complicated AWS were low education level (illiterate or primary studies compared with secondary or university education), hospitalization for AWS and drug abuse other than alcohol (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The model's receiver operating characteristic area was 0.718 (95% CI 0.643–0.793).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The profile of a patient with AWS treated in an internal medicine department is a middle-aged man who drinks wine and beer and has a long history of alcohol consumption and previous failed attempts at detoxification. This patient is also a regular user of healthcare facilities, is unemployed or retired and has a low education level and little family support.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In recent years, the mean consumption of wine per capita has fallen in Spain, while that of beer has increased. The consumption of spirits has remained stable.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patients with AWS belong to the 25–64-year age group. The types of alcohol most often consumed are beer (53%) and wine (34%).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> In terms of sex, men drink more frequently and in greater volumes than women. The most recent surveys on alcohol consumption in Spain show a prevalence of daily consumption up to 3-fold greater in males of all age groups.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,12</span></a> Consequently, all studies on AWS have shown a predominance of the male sex, between 80% and 90% of cases,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6,13</span></a> results similar to those recorded in this study. Recent data have alerted us to the increase in alcohol consumption among young women in Spain and in other countries,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,14</span></a> which might change this distribution in the future.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Studies have indicated that patients with AWS have an irregular pattern of alcohol consumption and that this pattern can be associated with varying degrees of hepatic lesions (alcoholic hepatitis) compared with those of patients with regular alcohol consumption (hepatic cirrhosis).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In contrast, our study recorded 83% of cases with regular alcohol consumption, similar findings to those of surveys on alcohol consumption in Spain, which observed that alcohol consumption in men is concentrated in traditional daily drinking (85%), while that of women is most common during the weekends (56%).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> In any case, it is likely that this aspect is difficult to determine during interviews of patients with alcohol dependence, in which the quantities and frequencies of consumption are frequently underestimated.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The association between socioeconomic conditions and the pattern of alcohol consumption varies according to the indicator being measured. The frequency of alcohol consumption is greater in individuals with a higher education level. If we consider the amount, which is especially relevant for patients with AWS, the quantity consumed is inversely related to education level.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12,17,18</span></a> This relationship is not homogeneous in terms of sex. The surveys in Spain have shown that the prevalence of male heavy drinkers is inversely proportional to education level. In contrast, hazardous drinking by women is lower at lower educational levels and higher in the higher social classes.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> Although they do not refer to patients with alcohol dependence, these differences could explain the results from other studies that assessed the relationship between the population's educational level and the rate of hospitalization for AWS, observing a negative correlation between the two.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Moreover, studies have reported that a low educational level is associated with poorer results after alcohol detoxification treatment<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and to a higher rate of readmissions for AWS.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">This study provides new data, indicating that a low educational level is independently associated with the risk of developing complicated AWS. This factor has not been previously considered in the analysis of predictors of severe AWS in hospitalized patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This condition might be associated with a more intense pattern of alcohol consumption that increases the risk not only of AWS but also of severe complications.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Other sociodemographic factors, such as an unstructured employment status and family status, did not affect the risk of having complicated AWS in the hospitalized patients. Although these variables can determine the long-term results of detoxification treatment and the state of addiction,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20–22</span></a> the results of the present study confirm those obtained by another study that also observed no relationship between these factors and the rate of short-term AWS outpatient treatment failure.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Patients who are admitted to medical areas for AWS usually have advanced symptoms upon their arrival at the hospital.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,23</span></a> Nevertheless, in our study, 60% of the patients developed AWS after a hospitalization for another reason, which probably indicates a deficiency in the early hospital detection of this syndrome, as has been already reported.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,24</span></a> This finding represents a lost opportunity for adopting preventive measures to decrease the risk of AWS.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The importance of the abuse of other drugs during the course of AWS has been poorly studied. Studies have reported that concomitant dependence on other abused drugs (opioids, hypnotics, cannabis, cocaine) is associated with the presence of DT and seizures.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> However, other studies have indicated that dependence on cocaine does not change the severity of the AWS but rather decreases the risk of seizures and the need for sedative treatment.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28–30</span></a> These results vary if the recent consumption of cocaine is considered, which has been related to the development of more severe forms of AWS.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> It is possible that patients who consume other drugs, especially cocaine, have more intense patterns of alcohol intake in terms of quantity and frequency<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> and that this is the cause of the relationship observed in the study.</p><p id="par0105" class="elsevierStylePara elsevierViewall">This study had a number of limitations. The recorded data are circumscribed to internal medicine departments, which means that not all patients with AWS in each hospital were included in the study, because many of the centers treat these patients in other departments (Psychiatry, Gastrointestinal, Neurology, etc.). In this respect, the patients hospitalized in internal medicine departments have greater comorbidity and possibly more severe AWS conditions. These patients’ clinical profile also differs from that of patients admitted to special alcoholism or detoxification units, which are also not represented in the study. All of these aspects entail a selection bias, as does the fact that the representation of hospitals that collaborated in the study does not include all the autonomous communities of Spain. Moreover, the data regarding the quantity of alcohol consumed, years of dependence and patterns of consumption are difficult to ensure during the interviews with patients with alcohol dependence, which could bias the results. Ultimately, for a number of variables with low incidence rates (e.g., consumption of opioids), the sample size could limit the interpretation of the results.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion, it is not easy to identify the factors related to the habit of alcohol consumption and complicated AWS. However, factors such as educational level and the consumption of other abused drugs could help identify patients with the risk of developing more severe forms of AWS.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">The database management was funded by the Alcohol and Alcoholism Workgroup of the Spanish Society of Internal Medicine. The investigators received no remuneration for their participation in the study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Authors/Collaborators</span><p id="par0120" class="elsevierStylePara elsevierViewall">Collaborating investigators: L. García-Pereña (University Hospital San Cecilio, Granada), F. Epelde (University Hospital Parc Tauli, Sabadell), R. Gómez-Méndez (University Hospital Lucus Augusti, Lugo) and AJ Chamorro-Fernández (University Hospital, Salamanca).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres907005" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec887287" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres907004" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec887288" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors/Collaborators" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-30" "fechaAceptado" => "2017-05-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec887287" "palabras" => array:4 [ 0 => "Alcohol withdrawal syndrome" 1 => "Epidemiology" 2 => "Educational level" 3 => "Risk factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec887288" "palabras" => array:4 [ 0 => "Síndrome de abstinencia alcohólica" 1 => "Epidemiología" 2 => "Nivel educativo" 3 => "Factores de riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or <span class="elsevierStyleItalic">delirium tremens</span>.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalization in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented <span class="elsevierStyleItalic">delirium tremens</span>. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5–18.7), low education level (OR, 3.4; 95% CI 1.6–7.3) and hospitalization for AWS (OR, 2.9; 95% CI 1.5–5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643–0.793).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la influencia de los factores epidemiológicos y sociodemográficos en el síndrome de abstinencia alcohólica (SAA) complicado.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio multicéntrico, observacional, prospectivo de enfermos consecutivos con SAA ingresados en servicios de Medicina Interna. Se registraron datos sociodemográficos, epidemiológicos, clínicos y evolutivos. Se definió SAA complicado como aquel que había cursado con convulsiones o <span class="elsevierStyleItalic">delirium tremens</span>.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 228 episodios de SAA en 219 pacientes. La edad media fue de 54,5 años (DE 11,5), y el 90,8% fueron hombres. El SAA fue la causa de ingreso en el 39,9%. El 27,1% de los casos presentaron crisis comiciales y el 32,4% <span class="elsevierStyleItalic">delirium tremens</span>. La cantidad ingerida de alcohol diaria fue 17,8 unidades de bebida estándar (DE 21,4), con 16,6 años de dependencia (DE 11,3). El patrón de abuso de alcohol fue regular en el 82,8%. Vivían casados o en pareja el 38,4% y el 45,6% tenía hijos. Un 72,7% estaba en paro o era pensionista. El 68,5% solo habían cursado estudios primarios. El 4,8% consumía cannabis, 5,2% cocaína y 3% opiáceos. Las variables independientes relacionadas con SAA complicado fueron: consumo de alguna droga diferente del alcohol (OR 5,3; IC 95% 1,5-18,7), bajo nivel de estudios (OR 3,4; IC 95% 1,6-7,3) y el ingreso por SAA (OR 2,9; IC 95% 1,5-5,6). El área ROC del modelo fue de 0,718 (IC 95% 0,643-0,793).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El consumo concomitante de otras drogas de abuso y el nivel bajo de estudios pueden ayudar en la identificación de pacientes con riesgo de SAA complicado.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Monte-Secades R, Blanco-Soto M, Díaz-Peromingo JA, Sanvisens-Bergé A, Martín-González MC, Barbosa A, et al. Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado. Rev Clin Esp. 2017;217:381–386.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CI, confidence interval; RR, relative risk; AWS, alcohol withdrawal syndrome.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">AWS, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>118 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Complicated AWS, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>110 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">RR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Years of alcohol consumption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">28.8 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">28.7 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Years of alcohol dependence<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">16.9 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">16.4 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Grams of alcohol daily<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">153.9 (100.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">190.7 (135.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Standard beverage units/day<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">15.6 (23.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">20.3 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">No. of attempts at detoxification<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.6 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">1 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">No. of previous AWS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.5 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">1.4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">No. of emergency department visits<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.5 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">1.1 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Intake of spirits, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">44 (37.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">34 (30.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.7 (0.4–1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Regular intake pattern, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">100 (52.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">89 (47.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.8 (0.5–1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Smoker, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">79 (66.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">71 (64.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.8 (0.4–1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Cannabis consumption, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">4 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">7 (6.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">1.8 (0.5–6.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Cocaine consumption, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">2 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">10 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">5.3 (1.1–25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Opioid consumption, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">2 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">5 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">2.5 (0.4–13.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Use of synthetic drugs, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">3 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">0.5 (0.4–0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Drug abuse other than alcohol, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">4 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">15 (13.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">4 (1.3–12.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Charlson index<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">1.9 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">2.1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Hospitalization for AWS, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">31 (26.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">60 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="middle">3.3 (1.9–5.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1525502.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Number of alcohol consumption-related visits to hospital emergency departments in the 12 months prior to admission.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Mean (SD).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics related to uncomplicated and complicated alcohol withdrawal syndrome (seizures or <span class="elsevierStyleItalic">delirium tremens</span>).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CI, confidence interval; RR, relative risk; AWS, alcohol withdrawal syndrome.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AWS, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>118 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complicated AWS, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>110 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (SD)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.2 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.6 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109 (92.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (89.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 (0.5–3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital >500 beds, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (70.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (62.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 (0.4–1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Population <10,000 inhabs, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (41.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (34.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.8–2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Single, separated or widowed, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (59.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (64.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (0.7–2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Has children, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (45.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.6–2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unemployed or retired, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (74.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (78.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (0.6–2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Illiterate or primary studies, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (58.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (78.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (1.3–4.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1525503.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Mean (SD).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of patients with uncomplicated and complicated alcohol withdrawal syndrome (seizures or <span class="elsevierStyleItalic">delirium tremens</span>).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CI, confidence interval; AWS, alcohol withdrawal syndrome; OR, odds ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Studies (illiterate or primary studies vs. secondary or university) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6–7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalization for AWS (vs. hospitalization for other reasons) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5–5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consumption of a drug other than alcohol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5–18.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1525504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis for the development of complicated alcohol withdrawal syndrome (seizures or <span class="elsevierStyleItalic">delirium tremens</span>).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Global status report on alcohol and health-2014 ed." ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ 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