Delta neutrophil index as a prognostic marker in emergent abdominal surgery

Jae Seung Soh, Sang-Woo Lim, Jae Seung Soh, Sang-Woo Lim

Abstract

Background: Delta neutrophil index (DNI) is the fraction of circulating immature granulocytes provided by a routine, complete blood cell analyzer. It is known to be a useful prognostic marker of sepsis. The aim of this study was to evaluate the role of DNI in the diagnosis and prognosis of patients who had undergone emergent surgery for an acute abdomen.

Methods: A total of 694 patients who had visited the emergency room for acute abdominal pain and undergone emergent abdominal surgery from May 2015 to September 2016 were retrospectively reviewed. Clinical characteristics, laboratory findings on the day of hospital visit, hospital stay, postoperative complications, and 30-day mortality were investigated.

Results: In the analysis of patients who had undergone an operation for acute peritonitis, the DNI was a good predictor for predicting 30-day mortality rate (area under the curve [AUC]: 0.826). It was not inferior to other laboratory values, including activated partial thromboplastin time (AUC: 0.729), C-reactive protein (AUC: 0.727), albumin (AUC: 0.834), prothrombin time (AUC: 0.816), and creatinine (AUC: 0.837) known to be associated with sepsis. Patients with high DNI displayed higher incidence of bacteremia and sepsis, longer hospital stay, higher postoperative complication rate, and higher 30-day mortality rate than patients with low DNI. Among patients diagnosed with acute appendicitis, the DNI was a useful marker for differentiating appendiceal perforation.

Conclusion: The DNI was a practical and useful marker for predicting the prognosis of patients who needed emergent abdominal surgery.

Keywords: acute abdomen; acute peritonitis; delta neutrophil index; mortality; predictive value.

© 2019 The Authors. Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
The order of investigations
Figure 2
Figure 2
Receiver operating characteristic curves comparing the ability of prothrombin time, partial thromboplastin time, C‐reactive protein, creatinine, albumin, and delta neutrophil index according to 30‐d mortality

References

    1. Pitts SR, Niska RW, Xu J, Burt CW. National hospital ambulatory medical care survey: 2006 emergency department summary. Natl Health Stat Rep. 2008;7:1‐38.
    1. Khanapure S, Nagral S, Nanavati AJ. A study of events between the onset of symptoms and hospital admission in patients with acute abdomen. Natl Med J India. 2017;30(2):65‐68.
    1. Harris N, Jou JM, Devoto G, et al. Performance evaluation of the ADVIA 2120 hematology analyzer: an international multicenter clinical trial. Lab Hematol. 2005;11(1):62‐70.
    1. Kratz A, Maloum K, O'Malley C, et al. Enumeration of nucleated red blood cells with the ADVIA 2120 hematology system: an international multicenter clinical trial. Lab Hematol. 2006;12(2):63‐70.
    1. Nahm CH, Choi JW, Lee J. Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis. Ann Clin Lab Sci. 2008;38(3):241‐246.
    1. Hwang YJ, Chung SP, Park YS, et al. Newly designed delta neutrophil index‐to‐serum albumin ratio prognosis of early mortality in severe sepsis. Am J Emerg Med. 2015;33(11):1577‐1582.
    1. Kim HW, Ku S, Jeong SJ, et al. Delta neutrophil index: could it predict mortality in patients with bacteraemia? Scand J Infect Dis. 2012;44(7):475‐480.
    1. Seok Y, Choi JR, Kim J, et al. Delta neutrophil index: a promising diagnostic and prognostic marker for sepsis. Shock. 2012;37(3):242‐246.
    1. Kong T, In S, Park YS, et al. Usefulness of the delta neutrophil index to predict 30‐day mortality in patients with upper gastrointestinal bleeding. Shock. 2017;48( 4):427‐435.
    1. Shin DH, Cho YS, Kim YS, et al. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. J Clin Lab Anal. 2018;32:e22177.
    1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care‐associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309‐332.
    1. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864‐874.
    1. Cho HY, Jung I, Kwon JY, Kim SJ, Park YW, Kim YH. The Delta Neutrophil Index as a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes: a retrospective study. PLoS ONE. 2017;12(3):e0173382.
    1. Yune HY, Chung SP, Park YS, et al. Delta neutrophil index as a promising prognostic marker in out of hospital cardiac arrest. PLoS ONE. 2015;10(3):e0120677.
    1. Han IM, Yoon C‐Y, Shin DH, et al. Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy. BMC Nephrol. 2017;18(1):94.
    1. Kim HW, Yoon JH, Jin SJ, et al. Delta neutrophil index as a prognostic marker of early mortality in gram negative bacteremia. Infect Chemother. 2014;46(2):94‐102.
    1. Lim TS, Kim BK, Lee JW, et al. Use of the delta neutrophil index as a prognostic factor of mortality in patients with spontaneous bacterial peritonitis: implications of a simple and useful marker. PLoS ONE. 2014;9(1):e86884.
    1. Park BH, Kang YA, Park MS, et al. Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis. BMC Infect Dis. 2011;11:299.
    1. Ahn JG, Choi SY, Kim DS, Kim KH. Limitation of the delta neutrophil index for assessing bacteraemia in immunocompromised children. Clin Chim Acta. 2014;436:319‐322.
    1. Park JH, Byeon HJ, Lee KH, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta‐analysis. Inflamm Res. 2017;66(10):863‐870.
    1. Cha YS, Lee KH, Lee JW, et al. The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department. Medicine. 2016;95(48):e5481.
    1. Kim OH, Cha YS, Hwang SO, et al. The use of delta neutrophil index and myeloperoxidase index for predicting acute complicated appendicitis in children. PLoS ONE. 2016;11(2):e0148799.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner