The delta neutrophil index (DNI) as a prognostic marker for mortality in adults with sepsis: a systematic review and meta-analysis

Abstract

We performed a meta-analysis to seek evidence for the usefulness of the delta neutrophil index (DNI) as a prognostic blood biomarker for mortality in the early stage of sepsis in adults. A literature search was performed using criteria set forth in a predefined protocol. Studies of adults with sepsis that provided a DNI measurement and that had mortality as the outcome, were included. Review articles, editorials, and non-human studies were excluded. The methodological quality of identified studies was assessed independently by two authors using the Quality in Prognosis Studies (QUIPS) tool. A total of 1,822 patients from eleven studies were ultimately included. Standardized mean differences between non-survivors and survivors were compared. An elevated DNI was associated with mortality in patients with sepsis (standardized mean difference [SMD] 1.22; 95% confidence interval 0.73–1.71; I2 = 91%). After excluding two studies—one that included paediatric patients and one with a disproportionately low mortality rate—heterogeneity was minimized (SMD 0.74, 95% confidence interval 0.53–0.94; I2 = 43%). Overall, the findings suggest that high DNI values are associated with mortality in septic patients.

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

“…DNI reflecting the ratio of immature granulocyte to the total neutrophil count can be automatically measured with myeloperoxidase and nuclear lobularity channels; this makes predicting the prognosis of various infectious or inflammatory conditions easy and reproducible [10]. Moreover, it indicates immature granulocyte count in the circulation irrespective of the total leucocyte count [8].…”

“…Biomarkers are defined as an objectively measured and evaluated indicator reflecting normal biologic or pathologic processes for the determination of diagnosis, prognosis or therapeutic interventions [30,31]. A previous meta-analysis assessed the role of DNI as a prognostic marker for mortality in sepsis [8]. However, the primary concern of this study was the relation between elevated DNI and mortality in patients with sepsis.…”

“…However, only a bivariate model for diagnostic test accuracy was considered, and the enrolled publications were not limited to emergent conditions with GI disorders. Furthermore, the measurement time of DNI was not uniform in the included studies [8] and, in some cases, it was not considered in the analysis [10].…”

“…DNI is a laboratory index which is calculated as the ratio of immature granulocyte numbers to the total neutrophil counts in peripheral circulation [7]. More specifically, it is calculated by subtracting the fraction of mature polymorphonuclear leukocytes from the sum of myeloperoxidase-reactive cells [7,8]. Because the formation of immature granulocytes precedes changes in total peripheral white blood cell counts in the process of granular leukocyte differentiation of infectious or inflammatory diseases, DNI has received attention as a biomarker for these conditions [8,9].…”

“…Previous reports have suggested the beneficial effect of DNI as a diagnostic and prognostic marker of various infectious or inflammatory diseases [8,10]. Sepsis originating from various organs is the most widely studied area for the application of DNI as a prognostic biomarker [8]. However, there are scarce data about optimal measurement time, and no studies have evaluated the potential efficacy of DNI as a prognostic biomarker of GI diseases with diagnostic test accuracy meta-analysis.…”