Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis

Byung H. Park, youngae kang, Moo S. Park, Won J. Jung, Su H. Lee, Sang K. Lee, Song Y. Kim, Se K. Kim, Joon Chang, Ji Y. Jung, Young S. Kim

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Abstract

Background: The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.Methods: One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.Results: Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.Conclusions: DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.

Original languageEnglish
Article number299
JournalBMC Infectious Diseases
Volume11
DOIs
Publication statusPublished - 2011 Nov 1

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Critical Illness
Sepsis
Neutrophils
Septic Shock
Disseminated Intravascular Coagulation
Granulocytes
Leukocytes
Leukocyte Count
C-Reactive Protein
Peroxidase
Intensive Care Units
Shock
Lactic Acid
Blood Cells
Infection

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

Park, Byung H. ; kang, youngae ; Park, Moo S. ; Jung, Won J. ; Lee, Su H. ; Lee, Sang K. ; Kim, Song Y. ; Kim, Se K. ; Chang, Joon ; Jung, Ji Y. ; Kim, Young S. / Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis. In: BMC Infectious Diseases. 2011 ; Vol. 11.
@article{8bddd53a1e014e95abc07e639c3a92c9,
title = "Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis",
abstract = "Background: The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.Methods: One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.Results: Forty four patients (42.7{\%}) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8{\%}). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5{\%} was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3{\%}; specificity, 91.0{\%}; positive predictive value, 88.6{\%}; and negative predictive value, 84.7{\%}). In 36 (82{\%}) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.Conclusions: DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.",
author = "Park, {Byung H.} and youngae kang and Park, {Moo S.} and Jung, {Won J.} and Lee, {Su H.} and Lee, {Sang K.} and Kim, {Song Y.} and Kim, {Se K.} and Joon Chang and Jung, {Ji Y.} and Kim, {Young S.}",
year = "2011",
month = "11",
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doi = "10.1186/1471-2334-11-299",
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Park, BH, kang, Y, Park, MS, Jung, WJ, Lee, SH, Lee, SK, Kim, SY, Kim, SK, Chang, J, Jung, JY & Kim, YS 2011, 'Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis', BMC Infectious Diseases, vol. 11, 299. https://doi.org/10.1186/1471-2334-11-299

Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis. / Park, Byung H.; kang, youngae; Park, Moo S.; Jung, Won J.; Lee, Su H.; Lee, Sang K.; Kim, Song Y.; Kim, Se K.; Chang, Joon; Jung, Ji Y.; Kim, Young S.

In: BMC Infectious Diseases, Vol. 11, 299, 01.11.2011.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis

AU - Park, Byung H.

AU - kang, youngae

AU - Park, Moo S.

AU - Jung, Won J.

AU - Lee, Su H.

AU - Lee, Sang K.

AU - Kim, Song Y.

AU - Kim, Se K.

AU - Chang, Joon

AU - Jung, Ji Y.

AU - Kim, Young S.

PY - 2011/11/1

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N2 - Background: The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.Methods: One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.Results: Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.Conclusions: DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.

AB - Background: The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.Methods: One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.Results: Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.Conclusions: DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.

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