Abstract Details

Title Supplemental Thiamine is not Associated with Mental Status Improvement in Patients Hospitalized with Acute Encephalopathy

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 084

Objective To determine whether supplemental thiamine before intravenous (IV) glucose is associated with the rate of mental status resolution in hospitalized patients admitted with encephalopathy.

Background Thiamine deficiency is common in hospitalized patients and may present with acute encephalopathy. The effect of routine thiamine supplementation on mental status improvement remains unclear.

Design/Methods In our IRB-approved study, we extracted demographic, clinical, and medication data for adult patients admitted with acute encephalopathy using suitable ICD-10 codes during calendar year 2017 from our hospital’s electronic health record database. Patients with underlying dementia were excluded. Patients were assigned to group T₁ (received thiamine before/with IV glucose), G₁ (received IV glucose before/without thiamine), or control (received neither). Primary outcome was time to mental status resolution from admission date which was determined through patient chart review by two investigators who were blinded to each other. The senior investigator (S.K.) then randomly audited 10% of charts to ensure quality of manual review and confirmed no errors. The association between initial thiamine/glucose administration and mental status resolution was modeled using the Cox proportional hazards model. Hazard ratios were referred to as “recovery rate ratios”, given that the outcome was beneficial.

Results We identified 262 patients: 38 (14.5%) in T_1,97 (37.0%) in G₁, and 127 (48.5%) in control group. Encephalopathy resolved in 30/38 (78.9%) in T1, 75/97 (77.3%) in G1, and 115/127 (90.6%) in control group at discharge. There was no significant difference between time to mental status resolution for T₁ (adjusted recovery rate ratio 1.11; 95% CI 0.74-1.68; p=0.62) or G₁ (0.88; 95% CI 0.65-1.18; p=0.39) compared to control group.

Conclusions Routine thiamine supplementation was not associated with improved rates of recovery from altered mentation in hospitalized patients admitted with acute encephalopathy. This finding is consistent with recent clinical trials that evaluated the use of thiamine supplementation in critically ill patients.

Authors/Disclosures
Daniel Zhou, MD (University of Pennsylvania) PRESENTER	The institution of Dr. Zhou has received research support from American Epilepsy Society. The institution of Dr. Zhou has received research support from National Institutes of Health.
Navya Joseph, MD (Bryan Physicians Network)	Dr. Joseph has nothing to disclose.
Kaeli Samson	No disclosure on file
Ismail M. Fahad, MBBS	Dr. Fahad has nothing to disclose.
	No disclosure on file
	No disclosure on file
Sachin Kedar, MD, FAAN (Emory University School of Medicine)	Dr. Kedar has nothing to disclose.

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