Predictive value of the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) score on admission for alcohol withdrawal delirium (AWD) in patients with alcohol use disorder (AUD): A prospective observational study.

BACKGROUND: Alcohol withdrawal delirium (AWD) is the most severe and potentially fatal manifestation of alcohol withdrawal syndrome (AWS). Early identification of patients at risk is critical for preventing medical complications and optimizing withdrawal management. Although the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar), is widely used to assess AWS severity, its predictive value for AWD remains unclear, particularly in Asian inpatient settings.

OBJECTIVE: To examine the incidence of AWS and AWD among patients with alcohol use disorder (AUD) in a Japanese rehabilitation center and to identify admission factors associated with AWD onset.

METHODS: Among 295 consecutively admitted patients, 273 were analyzed; 22 were excluded for ongoing AWD at admission. AWS was evaluated using CIWA-Ar throughout hospitalization. Associations between admission variables and AWD onset were analyzed using logistic regression and receiver operating characteristic (ROC) analysis.

RESULTS: Of 273 patients, 152 (55.7%) exhibited AWS and 24 (8.8%) developed AWD during hospitalization. Stepwise logistic regression identified only the CIWA-Ar score at admission as a significant predictor (odds ratio = 1.50; 95% confidence interval, 1.28-1.74; p < 0.001). ROC analysis yielded an area under the curve (AUC) of 0.906 with a CIWA-Ar cutoff of 4 (sensitivity 91.7%, specificity 84.3%).

CONCLUSIONS: The admission CIWA-Ar score is a strong and practical predictor of AWD in AUD inpatients. Even mild withdrawal symptoms may indicate early autonomic hyperactivity and high AWD risk, underscoring the need for vigilant monitoring and timely intervention.