A clinical prediction model for delirium tremens: development and validation in alcohol-dependent patients using multivariable logistic regression

Background Delirium tremens (DT) is a severe complication of alcohol withdrawal. This study aimed to develop and validate a prediction model for DT risk in hospitalized patients with alcohol dependence, using routine laboratory indicators. Methods We retrospectively analyzed 347 patients with alcohol dependence admitted to the Addiction Medicine Department of a tertiary psychiatric hospital from 2020 to 2024. The primary outcome was DT occurrence. A prediction model was constructed using logistic regression, with data split into training (70%) and validation (30%) sets by random sampling. Model performance was evaluated via the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). Results Of 347 patients, 118 (34%) developed DT. LASSO regression identified 11 predictors: history of DT, ammonia, creatinine, uric acid, total bilirubin (Tbiliary), albumin (ALB), gamma-glutamyl transferase (GGT), chloride (Cl), free triiodothyronine (Free_T3), free thyroxine (Free_T4), neutrophil percentage (NEU%), and red blood cell (RBC) count. Logistic regression confirmed that history of DT, ammonia, creatinine, ALB, Free_T3, NEU%, and RBC were independent risk factors (P< 0.05). The model demonstrated robust performance: AUC = 0.9881 [95% CI: 0.9794–0.9967] in the training set and 0.9599 [95% CI: 0.9142–1.0000] in the validation set, with high net benefit in DCA. Conclusions This model, incorporating readily available biomarkers and clinical history, effectively predicts DT risk. Limitations include its retrospective design (potential selection bias) and exclusion of clinical scales (e.g., CIWA-Ar). Prospective multicenter studies are needed to validate its generalizability.