Delta neutrophil index levels can be a good indicator to predict patients with chronic rhinosinusitis who need surgery

Abstract

Objectives Predicting the need for surgical treatment among patients with chronic rhinosinusitis (CRS) is challenging. The delta neutrophil index (DNI) has been proposed as a useful laboratory marker of immature granulocytes, which indicates infection or severe inflammation in several diseases. This study evaluated DNI as an early predictor of the need for surgery in patients with CRS. Methods A total of 117 patients diagnosed with CRS were enrolled in this retrospective and observational study. Medical records, including symptoms data, WBC count, ESR level, LUC count, Lund-Mackay scores, and DNI, were reviewed. The receiver operating characteristic (ROC) curves were analyzed to determine the optimal cut-off values for predicting surgery. Results Among 117 patients, 49 patients (41.9%) needed surgical intervention. The areas under the WBC, ESR, LUC, and DNI ROC curves were .571, .600, .592, and .782, respectively. The optimal cut-off value of DNI to predict surgery was .9%. The prognostic precision of DNI showed that the sensitivity was 59.2% and the specificity was 98.5%. In the analysis of risk factors, DNI levels were significantly associated with surgical intervention (odds ratio, 2.22; 95% confidence interval, 1.48-3.34; P < .01). Conclusions The level of DNI, which reflects the severity of the disease, may be a useful predictor for determining the need for surgical intervention in patients with CRS. This is the first literature to verify the role of DNI in upper airway disease.

Usefulness of the delta neutrophil index in predicting surgery in patients with foot and ankle infection

“…By using an automatic cell analyzer, clinicians can easily obtain the DNI value which reports the index of the IGs fraction. The DNI has been reported to have a significant relationship with the severity of several infectious diseases [ 3 ]. Also, many previous studies have suggested the DNI as a useful predictor of surgical decisions [ 3 ].…”

“…The DNI has been reported to have a significant relationship with the severity of several infectious diseases [ 3 ]. Also, many previous studies have suggested the DNI as a useful predictor of surgical decisions [ 3 ]. Furthermore, no additional cost or time is necessary for obtaining the DNI [ 11 ].…”

“…In previous studies of other diseases, the DNI was suggested as a useful biomarker that could predict surgical intervention [ 3 , 32 ]. For example, Lee et al [ 32 ] suggested that the initial DNI level can be a useful predictor for determining surgical intervention in patients with intestinal obstruction.…”

“…The area under the ROC curve of the initial DNI (0.543) was higher than that of CRP (0.460) and WBC (0.449) in these patients. Similarly, Son et al [ 3 ] reported that the DNI may be a good predictor for determining the necessity for operative treatment in chronic rhinosinusitis patients. Also in that setting, the area under the ROC curve of the initial DNI (0.782) was higher than that of WBC (0.571) and ESR (0.600).…”

“…For the radiographic evaluation, simple radiographs and magnetic resonance imaging studies can be used to obtain useful information regarding infective findings of the bone and soft tissue structure [ 2 ]. However, some limitations of the aforementioned tests remain due to their limited sensitivity and specificity [ 3 ].…”