Efficacy of the delta neutrophil index in predicting 30‐day mortality in COVID‐19 patients requiring intensive care

Birben, Birkan; Birben, Özlem; Akın, Tezcan; Akkurt, Gökhan; Surel, Aziz Ahmet; Erdem, Deniz

doi:10.1111/ijcp.13970

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…However, studies of DNI in COVID-19 patients are limited in the literature. Birben et al showed that DNI is an effective predictor of the intensive care unit mortality in 388 COVID-19 adult patients [ 17 ]. In our study, the prognosis of MIS-C was not evaluated, but DNI levels were found to be correlated with disease severity (Fig.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Calculated by subtracting the fraction of mature neutrophils from the sum of MPO-reactive cells, the delta neutrophil index (DNI) reflects the circulating fraction of immature neutrophils. In a study of 388 ICU patients, Birben et al found that the DNI, calculated at the time of hospital/ICU presentation, was significantly higher in COVID-19 patients who died within the first 30 days of ICU admission when compared to those who survived ( 269 ). Mechanistically, this relationship between increased neutrophil immaturity and poor outcome may be attributable to the pro-inflammatory nature of immature neutrophils, whose propensity for enhanced NET formation and cytokine production could contribute to systemic inflammation and tissue damage.…”

Section: Are Neutrophils a Potential Therapeutic Target For The Treatment Of Covid-19?mentioning

confidence: 99%

Neutrophils and COVID-19: Active Participants and Rational Therapeutic Targets

Hazeldine

Lord

2021

Front. Immunol.

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Whilst the majority of individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, experience mild to moderate symptoms, approximately 20% develop severe respiratory complications that may progress to acute respiratory distress syndrome, pulmonary failure and death. To date, single cell and high-throughput systems based analyses of the peripheral and pulmonary immune responses to SARS-CoV-2 suggest that a hyperactive and dysregulated immune response underpins the development of severe disease, with a prominent role assigned to neutrophils. Characterised in part by robust generation of neutrophil extracellular traps (NETs), the presence of immature, immunosuppressive and activated neutrophil subsets in the circulation, and neutrophilic infiltrates in the lung, a granulocytic signature is emerging as a defining feature of severe COVID-19. Furthermore, an assessment of the number, maturity status and/or function of circulating neutrophils at the time of hospital admission has shown promise as a prognostic tool for the early identification of patients at risk of clinical deterioration. Here, by summarising the results of studies that have examined the peripheral and pulmonary immune response to SARS-CoV-2, we provide a comprehensive overview of the changes that occur in the composition, phenotype and function of the neutrophil pool in COVID-19 patients of differing disease severities and discuss potential mediators of SARS-CoV-2-induced neutrophil dysfunction. With few specific treatments currently approved for COVID-19, we conclude the review by discussing whether neutrophils represent a potential therapeutic target for the treatment of patients with severe COVID-19.

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“…However, studies of DNI in COVID-19 patients are limited in the literature. Birben et al showed that DNI is an effective predictor of the intensive care unit mortality in 388 COVID-19 adult patients [17]. In our study, prognosis of MIS-C was not evaluated, but DNI levels were found to be correlated with disease severity.…”

Section: Discussionmentioning

confidence: 52%

Delta Neutrophil Index: A Potential Diagnostic Marker of Multisystem Inflammatory Syndrome in Children (MIS-C)

Karagöl¹,

Tehci²,

Güngör³

et al. 2021

Preprint

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Background Multisystem inflammatory syndrome in children (MIS-C) is a life threatening hiperinflamation syndrome emerging after COVID-19. The serum delta neutrophil index (DNI), reflects the fraction of circulating immature granulocytes and elevated 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. Methods This retrospective, observational study included 83 patients of MIS-C and 113 patients of COVID-19 and control group. C-reactive protein, absolute neutrophil count, absolute lymphocyte count, DNI and platelet count were recorded. Results The DNI levels were 4.60 ± 5.70% in the MIS C group and 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 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 the DNI levels and the severity of MIS-C. The cutoff value of DNI for predicting MIS-C was 0.45%. In the correlation analysis of DNI with CRP, ANC, ALC and platelet count, sensitivity, specificity, positive predictive value and negative predictive value were found to be 79.5%, 97.1%, 95.7%, and 85.3%, respectively. Conclusions DNI was identified as a predictive factor for diagnosis of 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.

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Efficacy of the delta neutrophil index in predicting 30‐day mortality in COVID‐19 patients requiring intensive care

Cited by 14 publications

References 16 publications

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

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

Neutrophils and COVID-19: Active Participants and Rational Therapeutic Targets

Delta Neutrophil Index: A Potential Diagnostic Marker of Multisystem Inflammatory Syndrome in Children (MIS-C)

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