Valproic Acid for the Management and Treatment of Delirium and Delirium-Associated Symptoms in Patients with a History of Alcohol Use Disorder
Poster #: 103
Session/Time: B
Author:
Janani Kavmadi Ranatunga, BS
Mentor:
David Spiegel, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Delirium is the most encountered psychiatric diagnosis in the general hospital setting and is associated with increased risk of patient institutionalization, dementia, and mortality (Witlox et al., 2010 & Sher et al., 2015). Valproic acid has been proposed as a potential adjunct in the management of delirium (Sher et al., 2015) in patients with Alcohol Use Disorder (Hammond et al., 2015). The primary objective of this study is to determine whether patients who have a history of or current Alcohol Use Disorder experiencing any cause of delirium (which can include alcohol withdrawal) respond as rapidly and effectively to pharmacological treatment with Valproic Acid as an adjunct when compared to current first line drugs.
METHODS:
A nonrandomized, non blinded, observational retrospective review of patients with Alcohol Use Disorder (AUD) who were treated with Valproic acid as an adjunctive therapy to delirium between 01/01/2013 and 12/31/2023 at the Sentara Norfolk General Hospital was performed using the Epic electronic database. The study included a sample size of 328 AUD patient charts, given by Sentara Analytics, based on the protocol inclusion criteria. 143 patients received Valproic Acid (VPA) and 185 who did not. Additional data analyzed included severity of delirium and agitation at diagnosis, side effects attributable to delirium, effectiveness of pharmacological therapy, and other medications used for the treatment of delirium such as antipsychotic, opioid, dexmedetomidine, and benzodiazepine.
RESULTS:
Chi-square analysis revealed significant differences in comorbidities, with a higher prevalence of hepatitis in the non-VPA group (28% vs. 17%, p = 0.032). Patients receiving VPA did not have significantly longer hospital stays (16.37 ± 21.67 days vs. 14.9 ± 55.34 days, p = 0.766) as determined by one-way ANOVA. Additionally, those in the VPA cohort were more likely to be prescribed antipsychotics (55.2% vs. 35.1%, p < 0.001), and benzodiazepines (60.8% vs. 49.7%, p = 0.045). The VPA cohort was not more likely to be prescribed opioids (28.7% vs 31.9%, p = 0.53) and dexmedetomidine (14.7% vs 18.9%, p = 0.312). Pearson correlation analysis within the VPA group demonstrated a strong positive correlation between the number of days on VPA and hospitalization length (r = 0.677, p < 0.001). There was a trend of improved RASS scores on VPA treatment: the average RASS scores of patients on VPA was 0.56 prior to VPA treatment, which improved to 0.22 and -0.3 on day 2 of VPA treatment and resolution of delirium respectively. No adverse effects were significantly associated with VPA use.
DISCUSSION:
Patients who received VPA were not associated with more days of hospitalization nor were they prescribed opioids and dexmedetomidine more often than patients who did not receive VPA. Patients who were prescribed VPA for more days spent more days in the hospital. Conclusion/Implications: Further research is needed to determine if there is a significant association between VPA use, hospitalization duration, and medication prescribing patterns in this patient population. There was a trend of improved RASS scores on VPA treatment. Additionally, no adverse effects were significantly associated with VPA use, indicating that VPA may be safe.
Delirium is the most encountered psychiatric diagnosis in the general hospital setting and is associated with increased risk of patient institutionalization, dementia, and mortality (Witlox et al., 2010 & Sher et al., 2015). Valproic acid has been proposed as a potential adjunct in the management of delirium (Sher et al., 2015) in patients with Alcohol Use Disorder (Hammond et al., 2015). The primary objective of this study is to determine whether patients who have a history of or current Alcohol Use Disorder experiencing any cause of delirium (which can include alcohol withdrawal) respond as rapidly and effectively to pharmacological treatment with Valproic Acid as an adjunct when compared to current first line drugs.
METHODS:
A nonrandomized, non blinded, observational retrospective review of patients with Alcohol Use Disorder (AUD) who were treated with Valproic acid as an adjunctive therapy to delirium between 01/01/2013 and 12/31/2023 at the Sentara Norfolk General Hospital was performed using the Epic electronic database. The study included a sample size of 328 AUD patient charts, given by Sentara Analytics, based on the protocol inclusion criteria. 143 patients received Valproic Acid (VPA) and 185 who did not. Additional data analyzed included severity of delirium and agitation at diagnosis, side effects attributable to delirium, effectiveness of pharmacological therapy, and other medications used for the treatment of delirium such as antipsychotic, opioid, dexmedetomidine, and benzodiazepine.
RESULTS:
Chi-square analysis revealed significant differences in comorbidities, with a higher prevalence of hepatitis in the non-VPA group (28% vs. 17%, p = 0.032). Patients receiving VPA did not have significantly longer hospital stays (16.37 ± 21.67 days vs. 14.9 ± 55.34 days, p = 0.766) as determined by one-way ANOVA. Additionally, those in the VPA cohort were more likely to be prescribed antipsychotics (55.2% vs. 35.1%, p < 0.001), and benzodiazepines (60.8% vs. 49.7%, p = 0.045). The VPA cohort was not more likely to be prescribed opioids (28.7% vs 31.9%, p = 0.53) and dexmedetomidine (14.7% vs 18.9%, p = 0.312). Pearson correlation analysis within the VPA group demonstrated a strong positive correlation between the number of days on VPA and hospitalization length (r = 0.677, p < 0.001). There was a trend of improved RASS scores on VPA treatment: the average RASS scores of patients on VPA was 0.56 prior to VPA treatment, which improved to 0.22 and -0.3 on day 2 of VPA treatment and resolution of delirium respectively. No adverse effects were significantly associated with VPA use.
DISCUSSION:
Patients who received VPA were not associated with more days of hospitalization nor were they prescribed opioids and dexmedetomidine more often than patients who did not receive VPA. Patients who were prescribed VPA for more days spent more days in the hospital. Conclusion/Implications: Further research is needed to determine if there is a significant association between VPA use, hospitalization duration, and medication prescribing patterns in this patient population. There was a trend of improved RASS scores on VPA treatment. Additionally, no adverse effects were significantly associated with VPA use, indicating that VPA may be safe.