Plasma neurofilament light chain levels are associated with delirium tremens in patients with alcohol use disorder

Delirium tremens (DT) is the most severe and life-threatening manifestation of alcohol withdrawal. Prompt identification and treatment are crucial in the clinical management of DT, but laboratory markers in this context are still lacking. Neurofilament light chain (NfL) has been proposed as a novel blood marker of neuroaxonal pathology. Therefore, we investigated the association between plasma NfL levels on admission and the occurrence of DT in patients with alcohol use disorder (AUD). NfL levels were measured on admission in 224 patients with AUD undergoing alcohol withdrawal treatment and in 116 healthy individuals. We monitored patients with AUD during the following 2 weeks of hospitalization and categorized them according to the prospective occurrence of DT (n = 25) or not (n = 199). Plasma NfL levels at admission were highest in patients who later developed DT, compared to AUD patients without DT, and healthy individuals (63.1 ± 47.2, 24.0 ± 22.4, 11.8 ± 6.1 pg/mL, respectively, p < 0.001). Receiver operating characteristic analysis revealed that a cut-off NfL level of 27.2 pg/mL could discriminate AUD patients who later developed DT (sensitivity: 80.0 %; specificity: 72.4 %; area under the curve: 0.84, p < 0.001), with an odds ratio of 9.43 (95 % CI 3.26–27.32; p < 0.001) for the risk of developing DT. Our findings suggest that NfL levels at admission may predict DT occurrence in patients with AUD and implicate neuroaxonal pathology in the pathophysiology of DT. Further research is needed to validate these findings and to explore the underlying neurobiological mechanisms.