Delta neutrophil index as a prognostic marker in emergent abdominal surgery

Abstract

BackgroundDelta 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.MethodsA 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.ResultsIn 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.ConclusionThe DNI was a practical and useful marker for predicting the prognosis of patients who needed emergent abdominal surgery.

Usefulness of delta neutrophil index as a biomarker to predict postoperative complication in patients who underwent esophagectomy

“…[ 33 ] In particular, studies conducted in the surgical field have shown that DNI could be useful for predicting disease severity, the necessity of surgical intervention, and prognosis. [ 11 , 15 – 17 , 34 , 35 ]…”

Delta Neutrophil Index for the Prediction of Prognosis in Acute Gastrointestinal Diseases; Diagnostic Test Accuracy Meta-Analysis

“…60 studies were finally excluded according to the exclusion criteria: not relevant to GI diseases (n = 42), pediatric study (n = 11), abstract only study (n = 2), animal study (n = 2), study protocol (n = 1), and systematic review or meta-analysis (n = 2). The remaining 12 articles [9,[17][18][19][20][21][22][23][24][25][26][27] were included in the systematic review. Among the 12 studies, Kim JW et al [22] explored the prognostic role of DNI measured at admission day 3, and the results of the study by Cha YS et al [26] cannot be extrapolated as a form of TP, FP, FN, or TN (although we contacted corresponding author, we could not get the crude numbers of TP, FP, FN, or TN).…”

“…Among the 12 studies, Kim JW et al [22] explored the prognostic role of DNI measured at admission day 3, and the results of the study by Cha YS et al [26] cannot be extrapolated as a form of TP, FP, FN, or TN (although we contacted corresponding author, we could not get the crude numbers of TP, FP, FN, or TN). Therefore, these two publications were excluded in the quantitative analysis, and a total of 10 studies [9,[17][18][19][20][21][23][24][25]27] were included in the meta-analysis of diagnostic test accuracy. Figure 1 presents a flow diagram showing the process for identifying the relevant studies.…”

“…From the 10 studies [9,[17][18][19][20][21][23][24][25]27] for the prediction of prognosis in GI diseases, a total of 2766 patients (518 patients with GI diseases vs. 2248 controls) were identified. Among all, eight studies [9,[17][18][19][20][21]23,27] were conducted in a case-control format, whereas two studies [24,25] were conducted in a cohort format. All the studies were conducted in Korea, and the median age of the population enrolled in the studies ranged from 35 to 70 years.…”

Positive Role of Delta Neutrophil Index (DNI) as a Prodiagnostic Marker in Cecal Ligation and Puncture (CLP)-Induced Sepsis Murine Model

“…Of the cellular biomarkers, delta neutrophil index (DNI) is well documented as a beneficial marker in determining the occurrence of candidemia [ 10 ] with systemic inflammatory response syndrome (SIRS) and a marker of disease severity in sepsis patients [ 11 , 12 , 13 ]. DNI via an automatic hemanalyzer is easily calculated by the cellular formula of delta neutrophil index = (neutrophil [%] + eosinophil [%] − polymorphonuclear neutrophil [PMN][%]).…”