Neutrophil to Lymphocyte Ratio as a Biomarker for Delirium Risk in Alcohol Withdrawal

Background: Delirium is a fluctuating abnormality in attention and awareness. One of the most important causes is alcohol withdrawal. Delirium carries high mortality, so prompt diagnosis is essential. Neutrophil-to-lymphocyte ratio (NLR) is a promising biomarker for predicting delirium due to alcohol withdrawal. Aim: To investigate the role of the NLR as a predictor of delirium in patients with Alcohol Dependence Syndrome (ADS) undergoing alcohol withdrawal: A prospective observational study. Settings and Design: The study was done in Government Medical College in Calicut, Kerala, India. Materials and Methods: Eighty male patients admitted for detoxification were assessed, with delirium diagnosed using the confusion assessment method. NLR was calculated from blood samples collected within 24 h of admission. Statistical Analysis: Descriptive statistics, group comparisons, and receiver operating characteristic (ROC) curve analysis were performed, with P < 0.05 considered statistically significant. Results: Delirium developed in 42.5% of patients, with a significantly higher mean NLR compared to those without delirium (3.67 vs. 2.06; P < 0.001). Older age, higher alcohol consumption, and a previous history of delirium were also associated with increased delirium risk. ROC curve analysis demonstrated that an NLR cutoff of 2.56 had good predictive value, with an area under the curve of 0.816, sensitivity of 79.4%, and specificity of 82.6%. Conclusion: The findings suggest that NLR is a valuable, cost-effective biomarker for early identification of delirium in ADS patients.