The delta neutrophil index is a prognostic factor for postoperative mortality in patients with sepsis caused by peritonitis

Abstract

IntroductionThe delta neutrophil index (DNI) represents the fraction of circulating immature granulocytes and is a marker of infection and sepsis. Our objective was to evaluate the usefulness of DNI for predicting in-hospital mortality within 30 days after surgery in patients with sepsis caused by peritonitis by means of comparing DNI, white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP) before and after surgery.Materials and methodsWe performed a retrospective analysis of demographic, clinical, and laboratory data. DNI, WBC count, neutrophil percentage, and CRP were measured before surgery, and at 12–36 h (day 1) and 60–84 h (day 3) after surgery.ResultsThere were 116 (73.7%) survivors and 44 (26.3%) non-survivors. The rates of septic shock, norepinephrine administration, renal replacement, mechanical ventilator therapy, and reoperation, the Simplified Acute Physiology Score-3 (SAPS3), and the Sepsis-related Organ Failure Assessment (SOFA) score were greater in non-survivors. DNI on day 3 was better than the other laboratory variables for predicting mortality. DNI was correlated with the SAPS3 (r = .46, p = .00) and SOFA score (r = .45, p = .00). The optimal cut-off DNI for predicting mortality was 7.8% (sensitivity: 77.3%; specificity: 95.9%). In receiver-operating characteristic curve analysis, DNI on day 3 was the best indicator of mortality (area under the curve: .880; 95% confidence interval: .80–.96).ConclusionsOur results indicate that DNI is better than other laboratory variables for predicting postoperative mortality in patients with sepsis caused by peritonitis. DNI > 7.8% on day 3 was a reliable predictor of postoperative mortality.

Immature granulocytes index as early marker of sepsis

“…In concordance with previous studies, we have shown that IG% <2.0% are able to exclude sepsis diagnosis, with a specificity of 90.9% and a sensitivity of 38.5% . Another study, on the other hand, adopted higher values for IG% cutoff . Buoro et al, who analyzed the IG% performance of the Sysmex XN‐9000 hematology analyzer in intensive care unit (ICU) patients, observed that IG% <10% represented a valid alternative compared to optical microscopy count for diagnosing sepsis in ICU patients.…”

“…In fact, this might be a positive aspect, since IG% was able to exclude earlier the possibility of infection, regardless of the organ affected. A study considering only sepsis caused by peritonitis revealed that delta neutrophil index (DNI) cutoff of 7.8% was better than other laboratory variables (white blood cells count, neutrophil percentage, and C‐reactive protein) for predicting postoperative mortality . New studies testing IG% in different kinds of infection might reveal in which cases it is a better biomarker, but as far, it has shown to be a very versatile predictor of sepsis diagnosis for various sites of infection, providing quick and reliable results.…”

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

“…Therefore, these three publications were rated as 'high-risk' in the 'reference standard' domain. Among the enrolled studies, only the study by Kim JW et al [22] measured DNI at day 3 and assessed the predictive role of DNI for 30-day mortality after emergent surgery due to acute peritonitis. Because the time interval between index test and reference standard was not suitable, unlike in other studies, this study was rated 'high-risk' in the 'flow/timing' domain.…”

“…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).…”

“…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). 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.…”