Neutrophil-lymphocyte ratio as a predictor of delirium tremens in hospitalized patients with alcohol withdrawal

• Published in: Alcohol (Fayetteville, N.Y.) N.Y.), 2023-06, Vol.109, p.43-48
• Main Authors: Yıldırım, Yusuf Ezel, Umut, Gökhan, Evren, Cüneyt, Yeral, Eylül, Secerli, Hikmet
• Format: Article
• Language: English
• Subjects: Alcohol use; Alcohol withdrawal; Alcohol Withdrawal Delirium - diagnosis; Alcoholism - diagnosis; Benzodiazepines; biomarkers; Comorbidity; Convulsions & seizures; Delirium; delirium tremens; Drug dosages; Drug use; Hospitalization; Humans; Inflammation; Leukocytes (neutrophilic); Lymphocytes; Mortality; neutrophil/lymphocyte ratio; Neutrophils; Oxidative stress; Pathophysiology; Prognosis; Retrospective Studies; Risk factors; Substance abuse treatment; Substance use disorder; Substance Withdrawal Syndrome - diagnosis; Tumor necrosis factor-TNF
• ISSN: 0741-8329; 1873-6823
• DOI: 10.1016/j.alcohol.2022.12.004

Delirium tremens (DT) is a severe form of alcohol withdrawal that can be fatal if not recognized early and treated appropriately. In our study, we aimed to determine the role of neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammation, in predicting the development of DT. This retrospective study was conducted in an alcohol and drug treatment center between March 2017 and March 2020. A total of 212 patients with a diagnosis of alcohol use disorder who were admitted to a special care unit after alcohol withdrawal were included. Blood tests were collected within 24 h of the patients' admission. Comparisons were made according to whether the patients developed DT during the hospitalization. DT was diagnosed in 24.1% of the patients. It was determined that higher NLR level (odds ratio [OR]: 4.38, 95% CI: 2.58–7.43) and history of DT (OR: 1.33, 95% CI: 1.23–11.73) are independent risk factors for the development of DT in the logistic regression analysis. The optimal cut-off value of NLR in predicting DT was 2.67 (sensitivity: 82.4%; specificity: 88.8%). The receiver operating characteristic (ROC) curve of NLR showed a larger area under the curve (AUC) than the curves of other systemic inflammation markers. NLR is a simple, practical, and inexpensive marker that can predict the development of DT in patients with alcohol withdrawal syndrome (AWS). •Delirium tremens (DT) can be fatal if not recognized early and treated appropriately.•Neutrophil-lymphocyte ratio (NLR) is a sensitive biomarker indicating inflammation.•This study aimed to determine the role of NLR in predicting DT in patients with AWS.•A history of DT and high NLR levels predicts the development of DT in AWS.•NLR is a useful marker that can predict the development of DT in patients with AWS.