Thiamine utilization and the lack of prescribing standardization: A critical examination

IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Todd N. Brothers , Margaret Furtado , Mohammad A. Al-Mamun
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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.

“硫胺素的使用与处方规范的缺失:一个关键的审查”。
目的:尽管缺乏美国临床指南,但在住院期间经常为硫胺素缺乏症开硫胺素处方。本研究旨在评估与缺乏相关的硫胺素处方模式和关键特征,以解决护理差距。方法:数据来源于2021年9月1日至2022年3月30日住院患者的电子健康记录。酒精使用障碍(AUD)的定义是临床研究所戒断评估评分阳性或入院时血清酒精水平阳性。老年患者被定义为年龄在50 - 65岁之间。队列1定义为:AUD,白蛋白< 4g/L, INR > 1.5,总胆红素> 3mg /dL。队列2定义为:年龄bb0 ~ 65岁,白蛋白< 4g/L,血红蛋白< 15g /dL,叶酸< 4ng/mL。使用多变量LASSO回归模型来确定高硫胺素剂量(100mg/天)的相关特征。结果:780例患者中,AUD 520例(66.7%),265例(50.1%),年龄在45-64岁之间。与平均血清白蛋白3.75g/L(3.3-4.2)、AST 35.07 U/L(11.00-42.00)、ALT 32.77 U/L(5.00-34.00)、总胆红素0.89(0.2-0.9)、INR 1.21(1.0-1.22)的非AUD患者相比,AUD组平均血清白蛋白4.16g/L (IQR: 3.8-4.5)、AST 73.55 U/L(23.75-82.00)、ALT 52.57 U/L(17.00-57.00)、总胆红素0.98(0.3-1.0)、INR 1.1(0.99-1.12)差异有统计学意义(p值< 0.05)。在老年队列中,136例(17%)患者的平均血清白蛋白为3.77g/L (3.4-4.2), AST为38.66 U/L(14.0-41.0), ALT为29.36 U/L(9.0-37.0),总胆红素为0.62mg/dL(0.30-0.90),直接胆红素为0.12 mg/dL(0.00-0.20),而非老年队列的平均血清白蛋白为4.10g/L (3.8-4.40), AST为66.44 U/L(21.0-75.0), ALT为50.03 U/L(16.00-53.75),总胆红素1.02mg/dL(0.30-1.00),直接胆红素为0.31 mg/dL(0.00-0.20)。在队列1中,40.6%的患者年龄在51-64岁之间,男性(66.5%),BMI < 25(36.4%)。队列2中,52.6%的患者年龄在65-70岁之间,男性(57.9%),BMI < 25(57.9%)。队列1的处方剂量为100mg(47.7%),口服(63.5%),肌肉注射(18.2%),每日(58.9%),1天疗程(49.4%)最常见。队列2最常见的是100mg(56.0%),口服(77.2%),每日(77.2%),1天疗程(29.8%)。AUD与每天服用较多的硫胺素(例如100毫克)或1.62(1.11-2.37)显著相关(p < 0.01)。结论:本研究证实,在住院期间,硫胺素的处方模式有所不同,并提示特定的实验室结果可能有助于确定与缺乏症相关的队列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Alcohol
Alcohol 医学-毒理学
CiteScore
4.60
自引率
4.30%
发文量
74
审稿时长
15.6 weeks
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.
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