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The Role of Neutrophil-Lymphocyte Ratio in Predicting Alcohol Withdrawal-Induced Seizures in Patients with Alcohol Use Disorder

Yıl 2025, Cilt: 26 Sayı: 3, 277 - 285

Öz

Objective: Alcohol withdrawal seizures are a medical condition, potentially life-threatening, that can occur after the cessation or reduction of alcohol consumption. Inflammatory changes play a major role in alcohol withdrawal symptoms (AWS). The neutrophil-lymphocyte ratio (NLR) is an accessible and straightforward method that can alert clinicians to possible risks in certain clinical conditions and support diagnosis. This study aimed to investigate whether NLR scores would contribute to the prediction of seizure development in patients with AWS.
Method: This study was conducted through electronic health records at Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery- Specific Care Unit of Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM). Thirty patients with alcohol withdrawal seizures (SZ+) and sixty-five alcohol use disorder patients without seizures (SZ-) were enrolled. The participants' biochemical, sociodemographic and clinical data were collected.
Results: The SZ+ group and SZ- group showed similarities in terms of age, mean duration of alcohol use and gender. Neutrophil levels were higher and lymphocyte levels were lower in the SZ+ group compared to the SZ- group. NLR found higher in SZ+ group. This difference between the two groups was significant.
Conclusion: NLR is a low-cost, widely available marker that can be used to predict alcohol withdrawal seizures.

Kaynakça

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington (VA): American Psychiatric Association, 2013.
  • Evren C (editör). Alkol ve Madde Kullanım Bozuklukları Temel Başvuru Kitabı. Ankara: Türkiye Psikiyatri Derneği, 2019.
  • Connor JP, Haber PS, Hall WD. Alcohol use disorders. Lancet. 2016;387(10022): 988–998.
  • World Health Organization. Global Status Report on Alcohol and Health. Geneva: WHO, 2018.
  • Batra A, Müller CA, Mann K, Heinz A. Alcohol dependence and harmful use of alcohol: diagnosis and treatment options. Dtsch Arztebl Int 2016;113(17): 301–310.
  • Tekkeşin N. Alkol kullanım bozukluğunda biyobelirteçler. Bağımlılık Dergisi 2024;25(4): 478–490.
  • Airagnes G, Ducoutumany G, Laffy-Beaufils B, et al. Alcohol withdrawal syndrome management: is there anything new? Rev Med Interne 2019;40(6): 373–379.
  • Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J 2013;22(2): 100–108.
  • Brust JCM. Acute withdrawal: diagnosis and treatment. In: Vinken PJ, Bruyn GW, Klawans HL, (editors). Handbook of Clinical Neurology. 1st ed. Amsterdam: Elsevier; 2014: 123–131.
  • Caputo F, Agabio R, Vignoli T, et al. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern Emerg Med 2019; 14(1): 143–160.
  • Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients. CNS Drugs 2003; 17(14): 1013–1030.
  • Hughes JR. Alcohol withdrawal seizures. Epilepsy Behav 2009;15(2): 92–97.
  • Rogawski MA. Update on the neurobiology of alcohol withdrawal seizures. Epilepsy Curr 2005; 5(6): 225–230.
  • Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs 2015; 75(4): 353–365.
  • Rubio G, Ponce G. Alcohol detoxification. In: Miller PM (editor). Interventions for Addiction. 1st ed. Amsterdam: Elsevier; 2013: 355–366.
  • Eyer F, Schuster T, Felgenhauer N, et al. Risk assessment of moderate to severe alcohol withdrawal—predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol 2011; 46 (4): 427–433.
  • Berggren U, Fahlke C, Berglund KJ, et al. Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. Alcohol Alcohol 2009; 44(4): 382–386.
  • Najjar S, Pearlman DM, Alper K, et al. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013; 10(1): 816.
  • Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122(7): 474–488.
  • Zulfic Z, Weickert CS, Weickert TW, et al. Neutrophil–lymphocyte ratio—a simple, accessible measure of inflammation, morbidity and prognosis in psychiatric disorders? Australas Psychiatry 2020; 28(4): 454–458.
  • Aydin I, Agilli M, Aydin F, et al. The reference ranges of neutrophil-lymphocyte ratio in different age groups. Gulhane Medical Journal 2015; 57(4): 414–418.
  • Kalelioglu T, Karamustafalioglu N. A new interpretation of neutrophil-lymphocyte ratio from psychiatric aspect. Bratisl Lek Listy 2019; 120(8): 604–605.
  • Yıldırım YE, Umut G, Evren C, et al. Neutrophil-lymphocyte ratio as a predictor of delirium tremens in hospitalized patients with alcohol withdrawal. Alcohol 2023; 190: 43–48.
  • Kulu M, Özsoy F, Demir B. Opiyat kullanım bozukluğu hastalarında inflamasyon: nötrofil/lenfosit, monosit/lenfosit, trombosit/lenfosit oranları ve ortalama trombosit hacmi. Bağımlılık Dergisi 2023; 24(1): 83–92.
  • Mazza MG, Lucchi S, Tringali AGM, et al. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84: 229–236.
  • Zengin İspir G, Tulacı RG. Relationship between withdrawal severity and inflammation parameters during the detoxification treatment of alcohol use disorder. Bağımlılık Dergisi 2024; 25(1): 23-30.
  • Hosseini S, Mofrad AME, Mokarian P, et al. Neutrophil to lymphocyte ratio in epilepsy: a systematic review. Mediators Inflamm 2022; 2022: 4973996.
  • Sutter R, Grize L, Fuhr P, et al. Acute-phase proteins and mortality in status epilepticus. Crit Care Med 2013; 41(6): 1526–1533.
  • Ravizza T, Gagliardi B, Noé F, et al. Innate and adaptive immunity during epileptogenesis and spontaneous seizures: evidence from experimental models and human temporal lobe epilepsy. Neurobiol Dis 2008; 29(1): 142–160.
  • Schomerus G, Corrigan PW, Klauer T, et al. Self-stigma in alcohol dependence: consequences for drinking-refusal self-efficacy. Drug Alcohol Depend 2011;114(1): 12–17.
  • McLaughlin DP, Pachana NA, McFarland K. Stigma, seizure frequency and quality of life: the impact of epilepsy in late adulthood. Seizure 2008; 17(3): 281–287.
  • Jacoby A. Epilepsy and stigma: an update and critical review. Curr Neurol Neurosci Rep 2008; 8(4): 339–344.
  • Wanke M, Macit R, Gülerce H. The stigmatization of drug addiction in South-East Turkey: the case of drug abuse prevention programme for youth project in Turkey. Addicta 2022; 9(2): 137–141.
  • Huang MC, Chen CH, Liu HC, et al. Differential patterns of serum brain-derived neurotrophic factor levels in alcoholic patients with and without delirium tremens during acute withdrawal. Alcohol Clin Exp Res 2011; 35(1): 126–131.
  • Schreiber N, Reisinger AC, Hatzl S, et al. Biomarkers of alcohol abuse potentially predict delirium, delirium duration and mortality in critically ill patients. iScience 2023; 26(10): 108044.
  • Bleich S, Bayerlein K, Hillemacher T, et al. An assessment of the potential value of elevated homocysteine in predicting alcohol‐withdrawal seizures. Epilepsia 2006; 47(5): 934–938.
  • Melamud MM, Bobrik DV, Brit PI, et al. Biochemical, hematological, inflammatory, and gut permeability biomarkers in patients with alcohol withdrawal syndrome with and without delirium tremens. J Clin Med 2024; 13(10): 2776.
  • Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta‐analysis. Alcohol Clin Exp Res 2014; 38(10): 2664–2677.
  • Rana A, Musto AE. The role of inflammation in the development of epilepsy. J Neuroinflammation 2018; 15(1): 144.
  • Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation in epilepsy. Nat Rev Neurol 2011; 7(1): 31–40.
  • Li H, Yang Y, Hu M, et al. The correlation of temporal changes of neutrophil-lymphocyte ratio with seizure severity and the following seizure tendency in patients with epilepsy. Front Neurol 2022; 13: 964923.
  • Pellegrino R, Paganelli R, Di Iorio A, et al. Temporal trends, sex differences, and age-related disease influence in neutrophil, lymphocyte count and neutrophil to lymphocyte-ratio: results from InCHIANTI follow-up study. Immun Ageing 2023; 20(1): 46.
  • Li J, Chen Q, Luo X, et al. Neutrophil‐to‐lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal 2015; 29(6): 437–443.
  • Öztürk YE, Kırlıoğlu M, Kıraç R. Risk factors in alcoholism and substance abuse. Selçuk Üniversitesi Sosyal Bilimler Meslek Yüksekokulu Dergisi. 2015; 18(2): 1–10.

Alkol Kullanım Bozukluğu Olan Hastalarda Alkol Yoksunluğuna Bağlı Nöbetlerin Öngörülmesinde Nötrofil-Lenfosit Oranının Rolü

Yıl 2025, Cilt: 26 Sayı: 3, 277 - 285

Öz

Amaç: Alkol yoksunluğu nöbetleri, potansiyel olarak hayatı tehdit eden, alkol tüketiminin kesilmesi veya azaltılmasından sonra ortaya çıkabilen tıbbi bir durumdur. Alkol yoksunluğu semptomlarında (AYS) inflamatuvar süreçler önemli rol oynamaktadır. Nötrofil-lenfosit oranı (NLO), klinisyenleri belirli klinik durumlarda olası risklere karşı uyarabilen ve tanıyı destekleyen erişilebilir ve basit bir yöntemdir. Bu çalışmanın amacı, NLO skorlarının AYS olan hastalarda nöbet gelişiminin öngörülmesine katkıda bulunup bulunmayacağını araştırmaktır.
Yöntem: Bu çalışma, hastanemiz Alkol ve Madde Bağımlılığı Araştırma, Tedavi ve Eğitim Merkezi (AMATEM) Özel Bakım Ünitesi'nde elektronik sağlık kayıtlarının incelenmesi ile gerçekleştirilmiştir. Alkol yoksunluk nöbeti geçiren otuz hasta (N+) ve nöbet geçirmeyen altmış beş alkol kullanım bozukluğu hastası (N-) çalışmaya dahil edilmiştir. Katılımcıların biyokimyasal, sosyodemografik ve klinik özellikleri ile ilgili veriler toplanmıştır.
Bulgular: N+ grubu ve N- grubu yaş, ortalama alkol kullanım süresi ve cinsiyet açısından benzerlik göstermiştir. N+ grubunda N- grubuna göre daha yüksek nötrofil ve daha düşük lenfosit seviyeleri saptandı. NLO, N+ grubunda daha yüksek bulundu. İki grup arasındaki bu fark istatistiksel olarak anlamlıydı.
Sonuç: NLO, alkol yoksunluğu nöbetlerini öngörmek için kullanılabilecek düşük maliyetli, yaygın olarak ulaşılabilen bir belirteçtir.

Kaynakça

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington (VA): American Psychiatric Association, 2013.
  • Evren C (editör). Alkol ve Madde Kullanım Bozuklukları Temel Başvuru Kitabı. Ankara: Türkiye Psikiyatri Derneği, 2019.
  • Connor JP, Haber PS, Hall WD. Alcohol use disorders. Lancet. 2016;387(10022): 988–998.
  • World Health Organization. Global Status Report on Alcohol and Health. Geneva: WHO, 2018.
  • Batra A, Müller CA, Mann K, Heinz A. Alcohol dependence and harmful use of alcohol: diagnosis and treatment options. Dtsch Arztebl Int 2016;113(17): 301–310.
  • Tekkeşin N. Alkol kullanım bozukluğunda biyobelirteçler. Bağımlılık Dergisi 2024;25(4): 478–490.
  • Airagnes G, Ducoutumany G, Laffy-Beaufils B, et al. Alcohol withdrawal syndrome management: is there anything new? Rev Med Interne 2019;40(6): 373–379.
  • Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J 2013;22(2): 100–108.
  • Brust JCM. Acute withdrawal: diagnosis and treatment. In: Vinken PJ, Bruyn GW, Klawans HL, (editors). Handbook of Clinical Neurology. 1st ed. Amsterdam: Elsevier; 2014: 123–131.
  • Caputo F, Agabio R, Vignoli T, et al. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern Emerg Med 2019; 14(1): 143–160.
  • Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients. CNS Drugs 2003; 17(14): 1013–1030.
  • Hughes JR. Alcohol withdrawal seizures. Epilepsy Behav 2009;15(2): 92–97.
  • Rogawski MA. Update on the neurobiology of alcohol withdrawal seizures. Epilepsy Curr 2005; 5(6): 225–230.
  • Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs 2015; 75(4): 353–365.
  • Rubio G, Ponce G. Alcohol detoxification. In: Miller PM (editor). Interventions for Addiction. 1st ed. Amsterdam: Elsevier; 2013: 355–366.
  • Eyer F, Schuster T, Felgenhauer N, et al. Risk assessment of moderate to severe alcohol withdrawal—predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol 2011; 46 (4): 427–433.
  • Berggren U, Fahlke C, Berglund KJ, et al. Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. Alcohol Alcohol 2009; 44(4): 382–386.
  • Najjar S, Pearlman DM, Alper K, et al. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013; 10(1): 816.
  • Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122(7): 474–488.
  • Zulfic Z, Weickert CS, Weickert TW, et al. Neutrophil–lymphocyte ratio—a simple, accessible measure of inflammation, morbidity and prognosis in psychiatric disorders? Australas Psychiatry 2020; 28(4): 454–458.
  • Aydin I, Agilli M, Aydin F, et al. The reference ranges of neutrophil-lymphocyte ratio in different age groups. Gulhane Medical Journal 2015; 57(4): 414–418.
  • Kalelioglu T, Karamustafalioglu N. A new interpretation of neutrophil-lymphocyte ratio from psychiatric aspect. Bratisl Lek Listy 2019; 120(8): 604–605.
  • Yıldırım YE, Umut G, Evren C, et al. Neutrophil-lymphocyte ratio as a predictor of delirium tremens in hospitalized patients with alcohol withdrawal. Alcohol 2023; 190: 43–48.
  • Kulu M, Özsoy F, Demir B. Opiyat kullanım bozukluğu hastalarında inflamasyon: nötrofil/lenfosit, monosit/lenfosit, trombosit/lenfosit oranları ve ortalama trombosit hacmi. Bağımlılık Dergisi 2023; 24(1): 83–92.
  • Mazza MG, Lucchi S, Tringali AGM, et al. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84: 229–236.
  • Zengin İspir G, Tulacı RG. Relationship between withdrawal severity and inflammation parameters during the detoxification treatment of alcohol use disorder. Bağımlılık Dergisi 2024; 25(1): 23-30.
  • Hosseini S, Mofrad AME, Mokarian P, et al. Neutrophil to lymphocyte ratio in epilepsy: a systematic review. Mediators Inflamm 2022; 2022: 4973996.
  • Sutter R, Grize L, Fuhr P, et al. Acute-phase proteins and mortality in status epilepticus. Crit Care Med 2013; 41(6): 1526–1533.
  • Ravizza T, Gagliardi B, Noé F, et al. Innate and adaptive immunity during epileptogenesis and spontaneous seizures: evidence from experimental models and human temporal lobe epilepsy. Neurobiol Dis 2008; 29(1): 142–160.
  • Schomerus G, Corrigan PW, Klauer T, et al. Self-stigma in alcohol dependence: consequences for drinking-refusal self-efficacy. Drug Alcohol Depend 2011;114(1): 12–17.
  • McLaughlin DP, Pachana NA, McFarland K. Stigma, seizure frequency and quality of life: the impact of epilepsy in late adulthood. Seizure 2008; 17(3): 281–287.
  • Jacoby A. Epilepsy and stigma: an update and critical review. Curr Neurol Neurosci Rep 2008; 8(4): 339–344.
  • Wanke M, Macit R, Gülerce H. The stigmatization of drug addiction in South-East Turkey: the case of drug abuse prevention programme for youth project in Turkey. Addicta 2022; 9(2): 137–141.
  • Huang MC, Chen CH, Liu HC, et al. Differential patterns of serum brain-derived neurotrophic factor levels in alcoholic patients with and without delirium tremens during acute withdrawal. Alcohol Clin Exp Res 2011; 35(1): 126–131.
  • Schreiber N, Reisinger AC, Hatzl S, et al. Biomarkers of alcohol abuse potentially predict delirium, delirium duration and mortality in critically ill patients. iScience 2023; 26(10): 108044.
  • Bleich S, Bayerlein K, Hillemacher T, et al. An assessment of the potential value of elevated homocysteine in predicting alcohol‐withdrawal seizures. Epilepsia 2006; 47(5): 934–938.
  • Melamud MM, Bobrik DV, Brit PI, et al. Biochemical, hematological, inflammatory, and gut permeability biomarkers in patients with alcohol withdrawal syndrome with and without delirium tremens. J Clin Med 2024; 13(10): 2776.
  • Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta‐analysis. Alcohol Clin Exp Res 2014; 38(10): 2664–2677.
  • Rana A, Musto AE. The role of inflammation in the development of epilepsy. J Neuroinflammation 2018; 15(1): 144.
  • Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation in epilepsy. Nat Rev Neurol 2011; 7(1): 31–40.
  • Li H, Yang Y, Hu M, et al. The correlation of temporal changes of neutrophil-lymphocyte ratio with seizure severity and the following seizure tendency in patients with epilepsy. Front Neurol 2022; 13: 964923.
  • Pellegrino R, Paganelli R, Di Iorio A, et al. Temporal trends, sex differences, and age-related disease influence in neutrophil, lymphocyte count and neutrophil to lymphocyte-ratio: results from InCHIANTI follow-up study. Immun Ageing 2023; 20(1): 46.
  • Li J, Chen Q, Luo X, et al. Neutrophil‐to‐lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal 2015; 29(6): 437–443.
  • Öztürk YE, Kırlıoğlu M, Kıraç R. Risk factors in alcoholism and substance abuse. Selçuk Üniversitesi Sosyal Bilimler Meslek Yüksekokulu Dergisi. 2015; 18(2): 1–10.
Toplam 44 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Psikiyatri, Madde Bağımlılığı
Bölüm Araştırma
Yazarlar

Enver Denizhan Ramakan 0000-0003-0768-5674

Ece Büyükakça Bu kişi benim 0009-0002-0879-0265

Cemrenaz Coşkun Bu kişi benim 0009-0006-4369-3160

İzgi Alnıak Bu kişi benim 0000-0002-9992-104X

Yayımlanma Tarihi
Gönderilme Tarihi 16 Kasım 2024
Kabul Tarihi 17 Şubat 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 26 Sayı: 3

Kaynak Göster

AMA Ramakan ED, Büyükakça E, Coşkun C, Alnıak İ. The Role of Neutrophil-Lymphocyte Ratio in Predicting Alcohol Withdrawal-Induced Seizures in Patients with Alcohol Use Disorder. Bağımlılık Dergisi. 26(3):277-285.

Bağımlılık Dergisi - Journal of Dependence