Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults

Abstract

BackgroundThis retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis.MethodsThe data from 650 patients were divided into positive and negative appendectomy groups (histologically normal appendicitis). The patients in the acute appendicitis group were further sub-divided into simple and complicated appendicitis groups.ResultsThe DNI was significantly higher in the positive group than in the negative appendectomy group (0.4 vs. −0.4, p < 0.001) as well as in the complicated group compared with that in the simple appendicitis group (1.2 vs. 0.3, p < 0.001). The DNI independently predicted a positive appendectomy and an acute complicated appendicitis in multivariate logistic regression analysis [odds ratio (OR) 2.62, 95% confidence interval (CI) (1.11~6.16), p = 0.028 and odds ratio (OR) 4.10, 95% confidence interval (CI) (2.94~5.80), p < 0.001]. The optimum cut-off for a positive appendectomy and acute complicated appendicitis were 0.2 [area under curve (AUC) 0.709] and 0.6 (AUC 0.727).ConclusionsWe suggest that obtaining a preoperative DNI is a useful parameter to aid in the diagnosis of histologically normal appendicitis and to differentiate between simple and complicated appendicitis.

A New And Early Marker In Diagnosis Of Acute Complicated Appendicitis: Immature Granulocyte

“…[15,17,18,[25][26][27] Studies on the use of IG measurements in AA diagnosis and the discrimination between SA and CA are limited. [22,28,29] Mathews et al [28] found that an increased IG% was significant in the discrimination of acute and perforated appendicitis in the pediatric age group, but it did not bring any additional benefit to this discrimination when compared with an increased CRP level and shift to left. Shin et al [22] found that the delta neutrophil index (DNI), the IG fraction in circulation, was a reliable marker in discriminating between acute non-perforated appendicitis and acute perforated appendicitis among elderly individuals.…”

“…Furthermore, they recommended carrying out immediate CT and emergency surgical intervention in elderly patients with suspicious appendicitis and a DNI >1.4. In another study, Shin et al [29] measured the DNI for use in discrimination between AA and CA among adults and showed that a DNI >2 could be a reliable parameter for AA and DNI >6 could identify CA.…”

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.…”