Neutrophil–Lymphocyte Ratio as a Predictor of Delirium Tremens in Alcohol Withdrawal: A Retrospective Study

Background: Delirium tremens is the most severe presentation of alcohol withdrawal and is associated with significant medical complications. Simple inflammatory markers obtained from routine blood counts could support early risk stratification.

Objectives: To estimate the frequency of delirium tremens among inpatients admitted with alcohol withdrawal and to evaluate the neutrophil–lymphocyte ratio (NLR) as a predictor of delirium tremens.

Methods: A retrospective record review was conducted among adult inpatients treated for alcohol withdrawal in a tertiary care teaching hospital. Sociodemographic variables, alcohol-use history, clinical course, and admission laboratory parameters were extracted from case records. NLR was calculated using neutrophil and lymphocyte percentages from the complete blood count. Patients were grouped into delirium tremens (DT) and no-DT categories. Group comparisons were performed using appropriate non-parametric tests, and receiver operating characteristic analysis was applied to determine the optimal NLR cut-off.

Results: Among 135 patients, 17 developed DT during admission. Median NLR was markedly higher in the DT group compared with the no-DT group. An NLR cut-off of ≥4.28 demonstrated good discrimination for DT with high specificity and an excellent negative predictive value. In regression analysis, increasing NLR remained independently associated with DT.

Conclusion: Elevated NLR at admission was associated with subsequent development of delirium tremens in alcohol withdrawal. NLR is an inexpensive, rapidly available marker that can complement clinical monitoring to identify patients who need closer observation and early escalation of care.