Predictors of Wernicke Encephalopathy in Adults Admitted for Acute Alcohol Induced Pancreatitis in the United States
Renuka Verma1, Prince Kwabla Pekyi-Boateng2, Maya Gabel3, Justin Kaur4, Jatin Kumar Passi4, Shaheen Sombans5, Sukhmeet Dhillon6, Balkiranjit Kaur Dhillon6, FNU Aisha6, Salini Ajitha7, Hemamalini Sakhthivel8, Kamleshun Ramphul6
1KIRK KERKORIAN SCHOOL OF MEDICINE, 2Neurology, Korle-Bu Teaching Hospital, 3University of Miami, 4Guru Gobind Singh Medical College, Faridkot, India, 5Fernandez Foundation, 6Independent Researcher, 7TD Medical college, 8One Brooklyn Health System/Interfaith Medical Ctr Program, Brooklyn, NY
Objective:
To identify risk factors of Wernicke Encephalopathy (WE) in adults admitted for acute alcohol-induced pancreatitis (AAIP).
Background:

WE, an acute reversible complication in chronic alcoholics, can occur in AAIP. Patients often have confusion, ophthalmoparesis, and nystagmus. Identifying potential risk factors can lead to sooner identification and hopefully prevention.


Design/Methods:
Adults hospitalized with a primary diagnosis of AAIP were queried from the 2016-2020 National Inpatient Sample (NIS). Factors influencing events of WE were estimated via multivariable regression analysis. 
Results:

We found 372,860 patients diagnosed with AAIP, of which 785 (0.2%) developed WE. Events of WE were more common in patients who had hypokalemia (aOR 2.131, p<0.01), acidosis (aOR 1.927, p<0.01), hypo-osmolarity/hyponatremia (aOR 1.818, p<0.01),  age≥ 60 years (aOR 1.818, p<0.01), history of alcohol abuse (aOR 5.251, p<0.01) and depression (aOR 2.007, p<0.01), experienced events of acute kidney injury (AKI) (aOR 2.843, p<0.01). While Hispanics showed higher odds of WE compared to Whites (aOR 1.286, p=0.044), no differences were seen between Blacks and Whites (aOR 0.907, p=0.310).  Meanwhile, lower odds of WE were reported among Medicaid-insured patients (vs. Medicare, aOR 0.746, p=0.010) and those with diabetes (aOR 0.697, p<0.01). No differences were seen in females vs. males (aOR 0.932, p=0.387). For AAIP admissions, events of WE led to poorer outcomes with higher mortality than those without events of WE (1.6% vs. 0.2%, aOR 2.616, p<0.01).


Conclusions:

Hypokalemia, acidosis, hypo-osmolarity/hyponatremia, age≥ 60 years, events of AKI, history of alcohol abuse, depression, and Hispanic race had higher odds of developing WE. These risk factors will help clinicians anticipate WE in adults presenting with AAIP allowing patients to receive appropriate counseling and prompt interventions to prevent disease progression.


10.1212/WNL.0000000000204632