The delta neutrophil index predicts development of multiple organ dysfunction syndrome and 30-day mortality in trauma patients admitted to an intensive care unit: a retrospective analysis

Abstract

No studies have examined the role of delta neutrophil index (DNI) reflecting on immature granulocytes in determining the severity of multiple organ dysfunction (MODS) and short-term mortality. This study investigated the utility of the automatically calculated DNI as a prognostic marker of severity in trauma patients who were admitted to an intensive care unit (ICU). We retrospectively analysed prospective data of eligible patients. We investigated 366 patients. On multivariable logistic regression analysis, higher DNI values at 12 h (odds ratio [OR], 1.079; 95% confidence interval [CI]: 1.037-1.123; p < 0.001) and 24 h were strong independent predictors of MODS development. Multivariable Cox regression analysis revealed that increased DNI at 12 h (hazard ratio [HR], 1.051; 95% CI, 1.024-1.079; p < 0.001) was a strong independent predictor of short-term mortality. The increased predictability of MODS after trauma was closely associated with a DNI > 3.25% at 12 h (OR, 12.7; 95% CI: 6.12-26.35; p < 0.001). A cut-off of >5.3% at 12 h was significantly associated with an increased risk of 30-day mortality (HR, 18.111; 95% CI, 6.988-46.935; p < 0.001). The DNI is suitable for rapid and simple estimation of the severity of traumatic injury using an automated haematologic analyser without additional cost or time.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Flow diagram of patient enrolment (A) and the criteria for trauma critical pathway activation (B).

Figure 2

Linear mixed model of the delta neutrophil index (DNI) to estimate significant differences between groups over time according to 30-day mortality (A) and development of multiple organ dysfunction syndrome (MODS) (B). The receiver operating characteristic curves for predictability of the DNI at 12 h (C) and 24 h (D) after admission according to MODS development.

Figure 3

The delta neutrophil index (DNI) as a predictor of 30-day mortality. Higher DNI values at 12 h (A) and 24 h (B) after admission were significantly associated with an increased risk of 30-day mortality among trauma patients admitted to an ICU.

Figure 4

Comparison of Harrell’s C-index for the delta neutrophil index (DNI) for the prediction of 30-day mortality according to time (A); and comparison of the area under the curve (AUC) for the DNI when predicting the development of multiple organ dysfunction syndrome (MODS) according to time (B). The Harrell’s C-index and AUC showed discriminative abilities for the risk stratification of 30-day mortality and development of MODS (statistical information is shown in supplements 2 and 3). (A) *Harrell’s C-index of DNI at 12 h was statistically superior to lactate, prothrombin time, and tCO2 on emergency department admission (p < 0.05). (B) *AUC of DNI at 12 h was statistically superior to lactate on emergency department admission and Injury Severity Score (p < 0.05). ¶AUC of DNI at 12 h was statistically inferior to the Sequential Organ Failure Assessment score at 24 h after emergency department admission (p < 0.05).