Which patients with intestinal obstruction need surgery? The delta neutrophil index as an early predictive marker

Abstract

PurposePredicting the need for surgical intervention among patients with intestinal obstruction is challenging. The delta neutrophil index (DNI) has been suggested as a useful marker of immature granulocytes, which indicate an infection or sepsis. In this study, we evaluated the impact of the DNI as an early predictor of operation among patients with intestinal obstruction.MethodsA total of 171 patients who were diagnosed with postoperative intestinal obstruction were enrolled in this study. Medical records, including data for the initial CRP level, WBC count, and DNI were reviewed. Receiver operating characteristic (ROC) curves were generated to clarify the optimal DNI cutoff values for predicting an operation.ResultsAmong the 171 patients, 38 (22.2%) needed surgical intervention. The areas under the initial CRP, WBC, and DNI ROC curves were 0.460, 0.449, and 0.543, respectively. The optimal cutoff value for predicting further surgical intervention according to the initial DNI level was 4.3%. The accuracy of the cutoff value was 74.9%, the sensitivity was 23.7%, and the specificity was 89.5% (positive predictive value, 23.7%; negative predictive value, 89.5%). In the multivariate analysis, initial DNI levels ≥ 4.3% were significantly associated with surgical intervention (odd ratio, 3.092; 95% confidence interval, 1.072–8.918; P = 0.037).ConclusionThe initial DNI level in patients with intestinal obstruction may be a useful predictor for determining the need for surgical intervention.

A New And Early Marker In Diagnosis Of Acute Complicated Appendicitis: Immature Granulocyte

“…Of the group, 234 of the patients (53.4%) were male, while 204 were female (46.6%). The median age was 30 years (17,25). The youngest patient was aged 18 years, and the oldest 92.…”

“…[14][15][16] Recent studies have demonstrated that IG can be used as an effective inflammatory marker. [15,17,18,[25][26][27] Studies on the use of IG measurements in AA diagnosis and the discrimination between SA and CA are limited. [22,28,29] Mathews et al [28] found that an increased IG% was significant in the discrimination of acute and perforated appendicitis in the pediatric age group, but it did not bring any additional benefit to this discrimination when compared with an increased CRP level and shift to left.…”

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

“…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).…”

“…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. Figure 1 presents a flow diagram showing the process for identifying the relevant studies.…”

“…From the 10 studies [9,[17][18][19][20][21][23][24][25]27] for the prediction of prognosis in GI diseases, a total of 2766 patients (518 patients with GI diseases vs. 2248 controls) were identified. Among all, eight studies [9,[17][18][19][20][21]23,27] were conducted in a case-control format, whereas two studies [24,25] were conducted in a cohort format. All the studies were conducted in Korea, and the median age of the population enrolled in the studies ranged from 35 to 70 years.…”