Todd N. Brothers , Margaret Furtado , Mohammad A. Al-Mamun
{"title":"Thiamine utilization and the lack of prescribing standardization: A critical examination","authors":"Todd N. Brothers , Margaret Furtado , Mohammad A. Al-Mamun","doi":"10.1016/j.alcohol.2023.10.041","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Thiamine is often prescribed for thiamine deficiency during hospitalization despite the lack of US-based clinical guidelines. This study aims to evaluate thiamine prescribing patterns and key characteristics associated with the deficiency to address gaps in care.</p></div><div><h3>Methods</h3><p>Data were obtained from electronic health records of hospitalized patients between September 1, 2021, and March 30, 2022. Alcohol use disorder (AUD) was defined by a positive Clinical Institute Withdrawal Assessment score or a positive serum alcohol level upon admission. Geriatric patients were defined as age ≥65. Cohort 1 was defined as: AUD, albumin <4 g/L, INR >1.5, and total bilirubin >3 mg/dL. Cohort 2 was defined as: age >65, albumin <4 g/L, hemoglobin <15 g/dL, and folate <4 ng/mL. A multivariable LASSO regression model was used to identify characteristics associated with higher thiamine dosing (>100 mg/day).</p></div><div><h3>Results</h3><p>Among 780 patients, 520 (66.7%) were identified as AUD, of which 265 (50.1%) were between the ages of 45–64 years. The AUD cohort was significantly different (<em>p</em> < 0.05) in the mean serum albumin 4.16 g/L (IQR: 3.8–4.5), AST 73.55 U/L (23.75–82.00), ALT 52.57 U/L (17.00–57.00), total bilirubin 0.98 (0.3–1.0), and INR 1.1 (0.99–1.12), compared to non-AUD patients with a mean serum albumin 3.75 g/L (3.3–4.2), AST 35.07 U/L (11.00–42.00), ALT 32.77 U/L (5.00–34.00), total bilirubin 0.89 (0.2–0.9), and INR 1.21 (1.0–1.22). In the geriatric cohort, 136 patients (17%) had a mean serum albumin 3.77 g/L (3.4–4.2), AST 38.66 U/L (14.0–41.0), ALT 29.36 U/L (9.0–37.0), total bilirubin 0.62 mg/dL (0.30–0.90), and direct bilirubin 0.12 mg/dL (0.00–0.20), compared to the non-geriatric cohort with a mean serum albumin 4.10 g/L (3.8–4.40), AST 66.44 U/L (21.0–75.0), ALT 50.03 U/L (16.00–53.75), total bilirubin 1.02 mg/dL (0.30–1.00), and direct bilirubin 0.31 mg/dL (0.00–0.20). In cohort 1, 40.6% patients were between 51 and 64 years old, (66.5%) male, and had a BMI <25 (36.4%). In cohort 2, 52.6% were between 65 and 70 years old, (57.9%) male, and had a BMI <25 (57.9%). Cohort 1 were prescribed a dose of 100 mg (47.7 %), oral (63.5%), intramuscular (18.2%), daily (58.9%), one-day duration (49.4%) most frequently. Cohort 2 were prescribed a dose of 100 mg (56.0%), oral (77.2%), daily (77.2%), one-day duration (29.8%) most frequently. The AUD was significantly associated with having a higher dosage (e.g., >100 mg) of thiamine prescribed per day OR 1.62 (1.11–2.37) (<em>p</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>This study confirms that thiamine prescribing patterns vary during hospitalization and suggest specific laboratory findings may aid in identifying cohorts associated with the deficiency.</p></div>","PeriodicalId":7712,"journal":{"name":"Alcohol","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Alcohol","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S074183292300321X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
Thiamine is often prescribed for thiamine deficiency during hospitalization despite the lack of US-based clinical guidelines. This study aims to evaluate thiamine prescribing patterns and key characteristics associated with the deficiency to address gaps in care.
Methods
Data were obtained from electronic health records of hospitalized patients between September 1, 2021, and March 30, 2022. Alcohol use disorder (AUD) was defined by a positive Clinical Institute Withdrawal Assessment score or a positive serum alcohol level upon admission. Geriatric patients were defined as age ≥65. Cohort 1 was defined as: AUD, albumin <4 g/L, INR >1.5, and total bilirubin >3 mg/dL. Cohort 2 was defined as: age >65, albumin <4 g/L, hemoglobin <15 g/dL, and folate <4 ng/mL. A multivariable LASSO regression model was used to identify characteristics associated with higher thiamine dosing (>100 mg/day).
Results
Among 780 patients, 520 (66.7%) were identified as AUD, of which 265 (50.1%) were between the ages of 45–64 years. The AUD cohort was significantly different (p < 0.05) in the mean serum albumin 4.16 g/L (IQR: 3.8–4.5), AST 73.55 U/L (23.75–82.00), ALT 52.57 U/L (17.00–57.00), total bilirubin 0.98 (0.3–1.0), and INR 1.1 (0.99–1.12), compared to non-AUD patients with a mean serum albumin 3.75 g/L (3.3–4.2), AST 35.07 U/L (11.00–42.00), ALT 32.77 U/L (5.00–34.00), total bilirubin 0.89 (0.2–0.9), and INR 1.21 (1.0–1.22). In the geriatric cohort, 136 patients (17%) had a mean serum albumin 3.77 g/L (3.4–4.2), AST 38.66 U/L (14.0–41.0), ALT 29.36 U/L (9.0–37.0), total bilirubin 0.62 mg/dL (0.30–0.90), and direct bilirubin 0.12 mg/dL (0.00–0.20), compared to the non-geriatric cohort with a mean serum albumin 4.10 g/L (3.8–4.40), AST 66.44 U/L (21.0–75.0), ALT 50.03 U/L (16.00–53.75), total bilirubin 1.02 mg/dL (0.30–1.00), and direct bilirubin 0.31 mg/dL (0.00–0.20). In cohort 1, 40.6% patients were between 51 and 64 years old, (66.5%) male, and had a BMI <25 (36.4%). In cohort 2, 52.6% were between 65 and 70 years old, (57.9%) male, and had a BMI <25 (57.9%). Cohort 1 were prescribed a dose of 100 mg (47.7 %), oral (63.5%), intramuscular (18.2%), daily (58.9%), one-day duration (49.4%) most frequently. Cohort 2 were prescribed a dose of 100 mg (56.0%), oral (77.2%), daily (77.2%), one-day duration (29.8%) most frequently. The AUD was significantly associated with having a higher dosage (e.g., >100 mg) of thiamine prescribed per day OR 1.62 (1.11–2.37) (p < 0.01).
Conclusions
This study confirms that thiamine prescribing patterns vary during hospitalization and suggest specific laboratory findings may aid in identifying cohorts associated with the deficiency.
期刊介绍:
Alcohol is an international, peer-reviewed journal that is devoted to publishing multi-disciplinary biomedical research on all aspects of the actions or effects of alcohol on the nervous system or on other organ systems. Emphasis is given to studies into the causes and consequences of alcohol abuse and alcoholism, and biomedical aspects of diagnosis, etiology, treatment or prevention of alcohol-related health effects.
Intended for both research scientists and practicing clinicians, the journal publishes original research on the neurobiological, neurobehavioral, and pathophysiological processes associated with alcohol drinking, alcohol abuse, alcohol-seeking behavior, tolerance, dependence, withdrawal, protracted abstinence, and relapse. In addition, the journal reports studies on the effects alcohol on brain mechanisms of neuroplasticity over the life span, biological factors associated with adolescent alcohol abuse, pharmacotherapeutic strategies in the treatment of alcoholism, biological and biochemical markers of alcohol abuse and alcoholism, pathological effects of uncontrolled drinking, biomedical and molecular factors in the effects on liver, immune system, and other organ systems, and biomedical aspects of fetal alcohol spectrum disorder including mechanisms of damage, diagnosis and early detection, treatment, and prevention. Articles are published from all levels of biomedical inquiry, including the following: molecular and cellular studies of alcohol''s actions in vitro and in vivo; animal model studies of genetic, pharmacological, behavioral, developmental or pathophysiological aspects of alcohol; human studies of genetic, behavioral, cognitive, neuroimaging, or pathological aspects of alcohol drinking; clinical studies of diagnosis (including dual diagnosis), treatment, prevention, and epidemiology. The journal will publish 9 issues per year; the accepted abbreviation for Alcohol for bibliographic citation is Alcohol.