The Delta Neutrophil Index as a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes: A retrospective study

Abstract

BackgroundHistological chorioamnionitis (HCA) is related to perinatal morbidity. However, there is no definite diagnostic method for detecting chorioamnionitis before delivery.MethodsWe evaluated whether the delta neutrophil index (DNI) was an effective early marker of HCA in patients with preterm premature rupture of membranes (PPROM). We retrospectively evaluated 149 women diagnosed with PPROM (gestational age, 20+0 to 36+6 weeks) at Severance Hospital from January 2013 to December 2014. The women were categorized into the following two groups: (a) PPROM without HCA and (b) PPROM with HCA. The maternal white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) level, and DNI were measured at admission. The DNI has been reported to reflect the fraction of circulating immature granulocytes associated with infection.ResultsOf the 149 patients, 87 were included in the PPROM without HCA group and 62 were included in the PPROM with HCA group. The interval between admission and delivery was significantly shorter in the PPROM with HCA group than in the PPROM without HCA group. There was no significant difference in the maternal WBC count. The serum CRP level, NLR, and DNI were significantly lower in the PPROM without HCA group than in the PPROM with HCA group, while the lymphocyte count was significantly lower in the PPROM with HCA group than in the PPROM without HCA group. A predictive equation was generated by combining the DNI, lymphocyte count, and CRP level, and the sensitivity and specificity for predicting a placental inflammatory response were 69.1% and 70.5%, respectively.ConclusionsThe DNI could be a predictive marker for HCA in patients with PPROM. Our predictive equation involving the DNI, lymphocyte count, and CRP level may be helpful for predicting the placental inflammatory response in patients with PPROM.

Effects of Anesthesia on Innate Immune Components in Orthopedic Surgery

“…The present study showed that postoperative WBC count and differential were not significantly correlated to the type of anesthesia. This is in agreement with Cho et al [15]. It appears that the changes in WBC counts happened as a response to the stress accompanying surgical operation that is the mirror of humeral and neural stimulation and that trauma and tissue damage associated with surgical incision is the main stimulant factor behind these stress responses [16].…”

Delta neutrophil index as a prognostic marker in emergent abdominal surgery

“…According to recent studies, DNI is a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes. 13 A higher DNI is a prognostic marker of out-of-hospital cardiac arrest 14 and an independent factor of mortality in septic acute kidney injury patients with continuous renal replacement therapy. 15 Septic condition of patients who visited the emergency room is an important factor for predicting their prognosis and mortality.…”

Changes in Umbilical and Cerebral Blood Flow in Pregnancies Diagnosed with Clinical Chorioamnionitis. Is Chorioamnionitis Predictable?

“…But almost all of these are based on the diagnosis of histological chorioamnionitis. Cho HY reported that the delta neutrophil index could be a predictive marker for histological chorioamnionitis in patients with PPROM (19). Pino MD et al did not detect any change on fetal Doppler parameters in 41 women with PPROM who subsequently developed clinical chorioamnionitis (20).…”