The Impact of Thiamine on Alcohol Withdrawal Delirium: A Nationwide Retrospective Study

Objective of this study: This study examined the protective effect of thiamine administration on the incidence of alcohol withdrawal delirium among patients with alcohol use disorder in Taiwan by evaluating a nationwide database. Methods We retrieved data for this retrospective cohort study from the Longitudinal Health Insurance Database 2000–2018. Patients receiving thiamine therapy after the diagnosis of alcohol use disorder were recruited as the thiamine therapy (TT) group, and the comparison group without TT (NTT group) included randomly assigned age and sex matched individuals with alcohol use disorder. Demographic data and comorbid medical disorders were evaluated and controlled. The cumulative defined daily dose (DDD) was analyzed to demonstrate the dose effect. Results Between 2000 and 2018, alcohol withdrawal delirium developed in 117 (5%) patients in the TT group and 107 (2%) in the NTT group. The incidence rate of alcohol withdrawal delirium was significantly lower in the TT group (19.66 per 1,000 person-years) compared to the NTT group (39.57 per 1,000 person-years). After adjusting for confounders, the NTT group had a significantly higher risk of alcohol withdrawal delirium compared to the TT group (aHR = 2.92, 95% CI: 2.20–3.88, p < 0.001). A dose-response relationship was observed: patients with lower cumulative DDDs of thiamine had a higher alcohol withdrawal delirium risk. Specifically, those with < 23 DDDs had the highest risk (aHR = 4.10, 95% CI: 2.16–5.48, p < 0.001), followed by those with 23–121 DDDs (aHR = 3.58, 95% CI: 2.33–5.48, p < 0.001) and those with > 121 DDDs (aHR = 2.66, 95% CI: 1.94–3.56, p < 0.001), suggesting a dose-dependent protective effect of thiamine against alcohol withdrawal delirium. Conclusions Our findings indicate that thiamine use is associated with a significantly reduced risk of alcohol withdrawal delirium in patients with AUD. Furthermore, a higher cumulative dose of thiamine is linked to a lower alcohol withdrawal delirium risk, highlighting a potential dose-dependent protective effect. These results underscore the importance of adequate thiamine supplementation in AUD patients as a preventive strategy.