Delta Neutrophil Index Is Associated with Vasculitis Activity and Risk of Relapse in ANCA-Associated Vasculitis

Abstract

PurposeDelta neutrophil index (DNI) represents the immature granulocytes count associated with neutrophil-consumption. We investigated whether DNI might be associated with Birmingham vasculitis activity score (BVAS) at diagnosis and could predict relapse during the follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Materials and MethodsWe reviewed the medical records of 97 patients having DNI results. Twenty patients had granulomatosis with polyangiitis (GPA), 58 had microscopic polyangiitis (MPA), and 19 had eosinophilic GPA (EGPA). We collected clinical and laboratory data including BVAS, five factor score (FFS), and DNI. The correlation coefficient and cumulative relapse free survival rate were obtained. The optimal cut-off of DNI was extrapolated by calculating the area under the receiver operator characteristic curve.ResultsDNI was significantly related to cross-sectional BVAS. Furthermore, among continuous variables, only DNI could reflect BVAS of GPA and MPA, but not EGPA. Severe AAV was defined as BVAS ≥20 (the highest quartile). At diagnosis, patients having DNI ≥0.65% had a significantly higher risk of severe GPA and MPA than those having not (relative risk 4.255) at diagnosis. During the follow-up, DNI ≥0.65% could predict the higher relapse rate.ConclusionDNI could reflect BVAS at diagnosis and furthermore, DNI ≥0.65% could not only identify severe AAV at diagnosis, but also predict relapse during the follow-up in patients with GPA and MPA.

Biomarkers in Vasculitides of the Nervous System

“…The so called delta neutrophil index (DNI), a simultaneous view at the number of immature granulocytes and the consumption of neutrophil granulocytes, correlates with the Birmingham vasculitis activity score at diagnosis—an instrument which helps assessing disease activity in patients with PSV (97). DNI values ≥0.65% were shown to be a surrogate parameter for a difficult progression of AAV and relapse in GPA and MPA during the observation period (97). This connection may be the result of the following considerations: T cells and macrophages release inflammatory cytokines that prime neutrophils and cause an increase in adhesion molecules on neutrophils and endothelial cells.…”

“…ANCA promote the interaction of neutrophils and endothelial cells, which results in the diapedesis of neutrophils through the vascular cell layers. Finally, activated neutrophils induce vasculitis by reactive oxygen radicals and degranulation (97–104).…”

Controlling Nutritional Status Score is Associated with All-Cause Mortality in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

“…We previously aimed to identify the clinical significance of certain independent baseline factors in predicting the poor outcomes of AAV, while considering these ethnic differences in disease presentation. All-cause mortality has been shown to be positively and inversely associated with the C-reactive protein (CRP)-to-serum albumin and the albumin-to-globulin ratios at diagnosis, respectively,89 while AAV-relapse has been found to be associated with the neutrophil-to-lymphocyte ratio, delta neutrophil index, and systemic immune-inflammation index at diagnosis 101112. Similarly, development of ESRD is known to be associated with systemic immune-inflammation and low levels of complement 3 at diagnosis 1213.…”

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Korea: A Narrative Review

“…DNI has been reported to be associated with conditions, in which mature neutrophils are consumed, such as sepsis and disseminated intravascular coagulation 71. Recently, Yoo, et al72 suggested a association between DNI and either current BVAS or relapse in 97 Korean patients with AAV. They indicated that DNI could reflect current BVAS and that DNI ≥0.65% could predict a higher rate of relapse during follow-up of AAV.…”