REVIEW OF: Pawar RD et al, Ann Intern Med 2022;175(2):191–197

STUDY TYPE: Retrospective observational study

Untreated thiamine deficiency can lead to Wernicke-Korsakoff syndrome, irreversible neurological damage, and death. Patients with alcohol use disorder (AUD) are particularly vulnerable, so most treatment guidelines therefore recommend thiamine supplementation for patients with AUD. But how often is it actually prescribed?

Researchers in this retrospective observational study (funded by the National Institutes of Health) used the Cerner Health Facts Database, which captures records from 133 hospitals. 14,998 patients with AUD were included in the analysis (mean age 52.2 years, 77% White), all of whom were admitted to the ICU with a diagnosis of alcohol withdrawal, septic shock, traumatic brain injury (TBI), or diabetic ketoacidosis (DKA). Researchers then determined how often thiamine supplementation was prescribed for patients with each of these diagnoses.

In all, only 51% of patients received thiamine supplementation. Patients with an alcohol withdrawal diagnosis received thiamine at a marginally higher rate (59%), but patients with the other diagnoses received it at lower rates: 41% of the time for TBI, 26% of the time for septic shock, and 24% of the time for DKA. Researchers were unable to gather data on dosing, only whether thiamine was prescribed. Nonetheless, thiamine supplementation was associated with a decreased overall in-hospital mortality rate: 6% for patients who received thiamine and 13% for those who did not.

Carlat Take

This study reveals the surprisingly low frequency of thiamine supplementation—a low-risk, low-cost, potentially life-saving intervention—in critically ill patients with AUD. Improve the quality of care for your patients, and those you may be consulting for, by following previously established thiamine supplementation guidelines.