Delta neutrophil index and C-reactive protein: a potential diagnostic marker of multisystem inflammatory syndrome in children (MIS-C) with COVID-19

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening hyperinflammation syndrome emerging after COVID-19. The serum delta neutrophil index (DNI) reflects the fraction of circulating immature granulocytes and is evaluated in infection and inflammation. The aim of this study is to evaluate the usefulness of DNI as a diagnostic marker in patients with MIS-C and to assess its role in determining the severity of MIS-C. This retrospective, observational study included 83 patients with MIS-C and 113 patients with COVID-19, and 102 healthy controls. C-reactive protein (CRP), the absolute neutrophil count (ANC), absolute lymphocyte count (ALC), DNI, and the platelet count were recorded. The DNI levels were 4.60 ± 5.70% in the MIS C group, 0.30 ± 0.99% in the COVID group, and 0.20 ± 0.56% in the control group ( p < 0.001). According to the severity of MIS-C, the DNI level was found to be 1.22% in mild MIS-C, 4.3% in moderate MIS-C, and 5.7% in severe MIS-C. There was a statistically significant correlation between DNI levels and the severity of MIS-C. The cutoff value of DNI for predicting MIS-C was 0.45%. In the analysis of the diagnostic performance of DNI compared with CRP, ANC, ALC and platelet counts, sensitivity, specificity, positive predictive value, and negative predictive value were found to be 79.5%, 97.1%, 95.7%, and 85.3%, respectively. Conclusions : The delta neutrophil index was identified as a diagnostic marker for MIS-C such as ANC, ALC, platelet count, and CRP. DNI levels in hemogram analysis may guide clinicians in determining the diagnosis and severity of MIS-C. What is Known: • Although CRP, sedimentation, ALC, ANC, platelet count, sodium, and albumin are used as first step tests, there is no specific laboratory marker used in the diagnosis of MIS C. • The serum delta neutrophil index (DNI) reflects the fraction of circulating immature granulocytes and is elevated in infection and inflammation. What is New: • DNI is a promising and easily accessible marker that can be used with other markers in the diagnosis and determines the severity of MIS C. • DNI is an easily accessible, inexpensive, and dynamic marker and its levels in simple hemogram analysis will guide pediatricians in determining the diagnosis and severity in MIS C.

Hematological, Inflammatory, Coagulation, and Oxidative/Antioxidant Biomarkers as Predictors for Severity and Mortality in COVID-19: A Prospective Cohort-Study

“…Recently it has been claimed that CRP is the excellent diagnostic of inflammatory biomarkers in children with COVID-19 that suffered from the multisystem inflammatory syndrome. 50 Another study found an association between an elevated level of D-dimer, which is considered a coagulation biomarker and an increased mortality rate in COVID-19. Soni et al 51 and our data support these claims.…”

Immature granulocytes: Innovative biomarker for SARS‑CoV‑2 infection

“…Birben et al ( 29 ), in their study on 388 patients with COVID-19 requiring intensive care, concluded that the DNI could be used as an effective prognostic biomarker for mortality in these patients. Moreover, according to the study by Karagol et al ( 30 ), there was a statistically significant association between the DNI levels and the severity of multisystem inflammatory syndrome in children with COVID-19.…”

Prognostic marker for mortality of COVID-19 patients in the intensive care unit: the delta neutrophil index

“…DNI is a reflection of the rate of immature granulocytes in the serum, and in recent years, the change in DNI in conditions of infection and inflammation has become the subject of many studies (8)(9)(10). Although there are several studies related to inflammation and sepsis, there are very few studies that have researched the relationship with COVID-19 (12,13). In a study by Karabel et al (12), the DNI values were compared in patients with multisystem inflammatory syndrome in children (MIS-C), COVID-19, and control group paediatric patients, and the highest DNI values were determined in the MIS-C group (p<0.001).…”

“…Although there are several studies related to inflammation and sepsis, there are very few studies that have researched the relationship with COVID-19 (12,13). In a study by Karabel et al (12), the DNI values were compared in patients with multisystem inflammatory syndrome in children (MIS-C), COVID-19, and control group paediatric patients, and the highest DNI values were determined in the MIS-C group (p<0.001). It was also determined that the DNI levels increased together with disease severity in the MIS-C group.…”