Delta neutrophil index as an early predictive marker of severe acute pancreatitis in the emergency department

Abstract

Background: Predicting severe acute pancreatitis (AP) in the early clinical stage is important for low morbidity and mortality. Delta neutrophil index (DNI) is used to detect infection and inflammation, but no previous studies have evaluated the usefulness of DNI as an early predictor of progression to severe AP (SAP).

Methods: The medical records of patients who were diagnosed with AP at the emergency department (ED) of Wonju Severance Christian Hospital from January 2012 to August 2016 were retrospectively reviewed. The initial DNI obtained in the ED was compared with other inflammatory markers to predict SAP. Multivariate logistic regression was used for statistical analysis.

Results: Of the 209 cases included in the analysis, 13 were classified as SAP. Compared to the DNI of the mild to moderately SAP group, that in the SAP group was considerably higher. The DNI showed a positive correlation with the Atlanta classification and bedside index of severity in AP. Using multivariate logistic regression analysis, DNI was an independent predictor of early SAP detection (odds ratio 1.122, 95% CI 1.045-1.205, p = 0.001). Among the biomarkers, DNI had the highest predictive value for SAP.

Conclusions: The DNI measured in the ED at presentation is a potentially useful adjunctive marker to predict SAP.

Keywords: Pancreatitis; delta neutrophil index; prognosis; severity.

Figures

Figure 1.

Box plot of white blood cell (WBC) counts, C-reactive protein (CRP) concentrations and delta neutrophil index (DNI) values by severity status of acute pancreatitis (AP).

Figure 2.

Receiver operating characteristic curve for predicting severe acute pancreatitis. The areas under the curve and 95% confidence intervals for indicators were 0.821 (0.762–0.870) for C-reactive protein (CRP), 0.880 (0.828–0.921) for delta neutrophil index (DNI) and 0.812 (0.752–0.863) for white blood cell (WBC). The model was adjusted for age, sex, diabetes mellitus, hypertension, liver cirrhosis, smoking status, gallstones and alcohol.