Usefulness of the delta neutrophil index to predict 30-day mortality in patients with ST segment elevation myocardial infarction

Abstract

This study aimed to evaluate the association between the delta neutrophil index (DNI), which reflects immature granulocytes, and the severity of ST-elevation myocardial infarction (STEMI), as well as to determine the significance of the DNI as a prognostic marker for early mortality and other clinical outcomes in patients with STEMI who underwent reperfusion. This retrospective, observational cohort study was conducted using patients prospectively integrated in a critical pathway program for STEMI. We included 842 patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI). Higher DNI values at time-I (within 2 h of pPCI; hazard ratio [HR], 1.075; 95% confidence interval [CI]: 1.046–1.108; p < 0.001) and time-24 (24 h after admission; HR, 1.066; 95% CI: 1.045–1.086; p < 0.001) were significant independent risk factors for 30-day mortality. Specifically, DNI values >2.5% at time-I (HR, 13.643; 95% CI: 8.13–22.897; p < 0.001) and > 2.9% at time-24 (HR, 12.752; 95% CI: 7.308–22.252; p < 0.001) associated with increased risks of 30-day mortality. In conclusion, an increased DNI value, which reflects the proportion of circulating immature granulocytes in the blood, was found to be an independent predictor of 30-day mortality and poor clinical outcomes in patients with acute STEMI post-pPCI.

The delta neutrophil index predicts development of multiple organ dysfunction syndrome and 30-day mortality in trauma patients admitted to an intensive care unit: a retrospective analysis

“…Although several pro-inflammatory cytokines like IL-6 can be usefully applied in clinical situations, additional costs, time, and new equipment must be considered for single or repeated measurements to predict the severity of the patients’ conditions. Recent studies have explored the DNI as an adjunct predictor because inflammatory markers that can be measured rapidly, easily, serially, and inexpensively are an unmet need 9 , 26 . The automatically calculated DNI is a more prompt and accurate method than manually counting immature granulocytes 10 , 14 .…”

“…The automatically calculated DNI is a more prompt and accurate method than manually counting immature granulocytes 10 , 14 . Several studies have shown that an increased DNI is associated with poor outcomes in specific disease conditions and can predict the severity of infection and sterile inflammation 9 – 11 , 14 , 15 . Although the pathophysiologic mechanisms by which DNI values are associated with severity of disease are not fully understood, several studies have elucidated the mechanisms by which immature granulocytes are released early and rapidly during severe inflammation 9 , 15 , 26 .…”

“…To assess the 95% CI and p -values for the IDI and continuous NRI, as well as the C-index and differences between models, a standard bootstrap method was used with resampling performed 1,000 times. We also assessed the continuous NRI and IDI at the final follow-up visit (30 days) to assess the improvement in performance of the survival model when DNI (as an additional parameter) is included 9 , 33 , 34 . To identify the effect of early significant intervention including transfusion, embolization, and surgery on the predictability of DNI values, we reviewed medical records to identify patients who received significant intervention before obtaining DNI within 12 h after ED admission.…”

“…Technological advances in automated haematological analysers have enabled the acquisition of the delta neutrophil index (DNI) using leukocyte differentials obtained from two independent channels, the myeloperoxidase tungsten-halogen channel and the lobularity/nuclear density channel 8 , 9 . The DNI reflects the proportion of circulating immature granulocytes and is calculated as the difference between the leukocyte differentials measured in the myeloperoxidase channel and the differentials detected in the lobularity channel 8 , 9 .…”

“…Technological advances in automated haematological analysers have enabled the acquisition of the delta neutrophil index (DNI) using leukocyte differentials obtained from two independent channels, the myeloperoxidase tungsten-halogen channel and the lobularity/nuclear density channel 8 , 9 . The DNI reflects the proportion of circulating immature granulocytes and is calculated as the difference between the leukocyte differentials measured in the myeloperoxidase channel and the differentials detected in the lobularity channel 8 , 9 . A previous study showed that the DNI (as calculated using an automated blood cell analyser) was strongly correlated with the manual immature granulocyte counts (r = 0.75, p < 0.05) 10 ; an increase in the number of immature granulocytes in circulation is an important criterion in the diagnosis of systemic inflammatory response syndrome 11 .…”