Peripheral inflammatory biomarkers associated with alcohol withdrawal delirium in alcohol use disorder: a cross-sectional study

Background: Alcohol withdrawal delirium (AWD) is a serious complication of alcohol use disorder associated with high morbidity and mortality. Systemic inflammation has been implicated in the pathophysiology of severe alcohol withdrawal states, but the clinical value of simple peripheral inflammatory biomarkers is unclear.Objectives: This study aimed to compare peripheral inflammatory indices among patients with AWD, patients with alcohol withdrawal without delirium, and healthy controls, and determine whether these indices differentiate AWD from alcohol withdrawal without delirium.Methods: This retrospective study included 232 adults (194 males, 38 females), of whom 81 had AWD, 91 had alcohol withdrawal without delirium (AWS), and 60 were healthy controls. Sociodemographic, clinical, and laboratory data obtained within the first 24 hours of admission were compared. Receiver operating characteristic analyses and multivariable logistic regression were performed.Results: Several inflammatory indices (particularly the monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-albumin ratio (CAlb)) were significantly higher in AWD than in both comparison groups, whereas platelet counts did not differ. In the regression model, neutrophil-to-lymphocyte ratio (NLR) was independently associated with AWD (OR = 1.84, 95%CI: 1.02–3.31, p = .042) providing incremental prognostic value beyond established risk factors such as AWD history (OR = 9.09, 95%CI:2.65–31.20, p < .001) and withdrawal severity (OR = 1.18, 95%CI:1.09–1.28, p < .001). MLR best differentiated AWD from uncomplicated withdrawal (AUC = 0.760; Cutoff > 0.32; Sensitivity:71.8%, Specificity:72.5%), while NLR best distinguished AWS from controls (AUC = 0.796; Cutoff > 1.83; Sensitivity:68.1%, Specificity:85.0%).Conclusion: Simple peripheral inflammatory indices, particularly NLR and MLR, are independently associated with AWD and offer diagnostic utility to complement clinical assessment in risk stratification.