Thiamine supplementation in hospitalized patients with altered mental status: does it help?

ABSTRACT

Objective

To describe thiamine-prescribing patterns and to study the association of thiamine supplementation with clinical outcomes in hospitalized patients with altered mental status (AMS).

Methods

We conducted a retrospective cohort study of all adult hospitalized patients with AMS with index admission in calendar year 2017. We studied the association of a) supplemental thiamine and b) timing of thiamine relative to glucose, with hospital outcomes – length of stay (LOS), 90-day readmission rates, and mortality rates – using linear, logistic, and extended Cox models, respectively. We also modeled association of supplemental thiamine on time to resolution of AMS using extended Cox models in patients admitted with AMS.

Results

Of 985 patients, 178 (18%) received thiamine, including 123 (12.5%) who received thiamine before, with, or without glucose (thiamine first). We identified 365 (37%) patients who received intravenous glucose before or without thiamine (glucose first). We found that patients who received glucose first had longer LOS and higher rate of in-hospital deaths compared to those who did not. Patients who received thiamine supplementation had longer LOS compared to those who did not. There were no significant differences in other hospital outcomes or AMS resolution by discharge compared to their respective reference groups.

Conclusion

Although thiamine supplementation was not associated with better hospital or cognitive outcomes, we do not have enough evidence to suggest a change in current practice. Thiamine must be administered prior to glucose in hospitalized patients with AMS.

KEYWORDS:

• Thiamine
• encephalopathy
• altered mental status
• hospitalization
• outcomes

Acknowledgments

We would like to thank Dr. Lynette Smith, Ph.D. (University of Nebraska Medical Center, Department of Biostatistics) for providing additional review of the statistics performed in this study.

Disclosure of financial/other conflicts of interest

Dr Kedar has licensed technology with EON Reality Inc. All other authors have no relevant conflicts of interest to disclose. A reviewer on this manuscript has disclosed a consulting agreement with Celgene USA unrelated to this manuscript. Another reviewer on this manuscript has disclosed having served as a medical expert in legal cases of Wernicke encephalopathy. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All authors are located at the University of Nebraska Medical Center in Omaha, Ne.

Table

Data availability statement

De-identified data not published within this manuscript will be shared with any qualified investigator by the corresponding author, S.K., upon reasonable written request.

Additional information

Funding

The authors have no funding to report.