Stroke patients in an alcohol withdrawal state: A cross- sectional analysis of clinical profiles and functional outcomes in a tertiary hospital in the Philippines

Abstract

Background & Objective: Acute stroke patients are at risk for a wide range of complications. When these complications overlap with acute Alcohol Withdrawal Syndrome (AWS), they can lead to adverse events such as death, disability, or delayed recovery. However, evidence regarding this overlap, particularly in Asian populations, is scarce. This study aims to characterize the clinicodemographic features and outcomes of Filipino stroke patients with AWS and investigate the relationship between AWS severity and functional recovery.

Methods: We conducted a retrospective, cross-sectional study of adult stroke patients with AWS admitted to the Department of Neurology at a tertiary hospital from 2018 to 2023. Demographic data, clinical features, complications, and outcomes were collected. Associations between AWS severity (Clinical Institute Withdrawal Assessment of Alcohol Scale–Revised [CIWA- Ar]), stroke severity (National Institutes of Health Stroke Scale [NIHSS]), and functional outcomes (modified Rankin Scale [mRS]) were analyzed using Spearman’s rho correlation and Fisher’s exact test.

Results: During the study period, 36 patients met the inclusion criteria. There was a strong male predominance (94.4%), with the majority aged 40–59 years (77.8%). Hemorrhagic stroke was the most common subtype (83.3%). Upon admission, 47.2% presented with mild AWS, and 55.6% manifested withdrawal symptoms within 24 hours to one week of admission. The mortality rate was 22.2% (95% CI: 10.1–39.2%), while 25.0% (95% CI: 12.1–42.2%) of patients were discharged with no significant disability (mRS 0–2). A significant positive correlation was found between AWS severity (CIWA-Ar scores) and functional disability (mRS) (ρ = 0.360, p = 0.031). Baseline demographic factors did not show a statistically significant association with functional outcomes.

Conclusion: Increasing severity of alcohol withdrawal is significantly associated with poorer functional outcomes in acute stroke patients. These findings emphasize the need for early risk stratification using the CIWA-Ar scale and the implementation of multidisciplinary management protocols to optimize recovery in this vulnerable population.