Use of the Delta Neutrophil Index as a Prognostic Factor of Mortality in Patients with Spontaneous Bacterial Peritonitis: Implications of a Simple and Useful Marker

Abstract

BackgroundSpontaneous bacterial peritonitis (SBP) is a common and life-threatening infection in patients with advanced cirrhosis. The prognostic value of a novel marker, the delta neutrophil index (DNI), was investigated relative to mortality in patients with SBP.Materials & MethodsSeventy-five patients with SBP were studied from April 2010 to May 2012. DNI at initial diagnosis of SBP was determined and compared with 30-day mortality rates.ResultsOf the patients, 87.7% were men, and the median age of all patients was 59.0 yrs. The area under the receiver-operating characteristic (ROC) curve of DNI for 30-day mortality was 0.701 (95% confidence interval [CI], 0.553–0.849; p = 0.009), which was higher than that of C-reactive protein (0.640, 95% CI, 0.494–0.786; p = 0.076) or the model for end-stage liver disease score (0.592, 95% CI, 0.436–0.748; p = 0.235). From the ROC curve, with the sum of sensitivity and specificity, the cutoff value of DNI was determined to be 5.7%. In the high-DNI group (DNI ≥5.7%), septic shock and 30-day mortality were more prevalent compared with the low-DNI group (84.2% vs. 48.2%, p = 0.007; 57.9% vs. 14.3%, p<0.001, respectively). Patients with an elevated DNI had a higher risk of 30-day mortality compared with those with a low DNI (4.225, 95% CI, 1.631–10.949; p = 0.003).ConclusionA higher DNI at the time of SBP diagnosis is an independent predictor of 30-day mortality in patients with SBP.

Delta Neutrophil Index as a Prognostic Marker of Early Mortality in Gram Negative Bacteremia

“…As a result, we cannot be sure that our findings are applicable to infectious diseases. The second limitation results from our exclusion of patients with serious underlying illnesses like hematologic malignancy and the mortality rate was relatively low in our study compared to other general reports [7, 11, 15]. Third, our study used 7.6% as the cut-off DN value to predict mortality in patients with GNB.…”

Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments

“…In a recent study, Kim et al (29) investigated the usefulness of DNI as an early predictor of acute complicated appendicitis in children, and observed a significantly higher median DNI in patients with acute complicated appendicitis (2.2%), compared with those with non-complicated appendicitis (0%; P <0.001) (29). Furthermore, a DNI cut-off value of 5.7% was used to determine 30-day mortality at the time of diagnosis of spontaneous bacterial peritonitis (30). In addition, whole-body ischaemia/reperfusion after cardiac arrest can activate a severe systemic inflammatory response associated with sterile insult; in this context, Yune et al (20) demonstrated that a DNI >8.4% on day 1 (HR, 3.227; 95% CI, 1.485-6.967; P ¼ 0.001) and >10.5% on day 2 (HR, 3.292; 95% CI, 1.662-6.519; P < 0.001) were associated with increased 30-day mortality in patients with out-of hospital cardiac arrest.…”

Delta neutrophil index as a prognostic marker in emergent abdominal surgery

“…Therefore, there have been efforts to find proper biomarkers associated with sepsis. The utility of DNI value in patients with sepsis and bacteremia has been reported in several studies . In a previous study, the DNI value was used as an early marker of disease severity in critically ill patients with sepsis .…”

“…The utility of DNI value in patients with sepsis and bacteremia has been reported in several studies. [6][7][8]16,17 In a previous study, the DNI value was used as an early marker of disease severity in critically ill patients with sepsis. 18 However, in another study, the use of DNI for predicting bacteremia or sepsis was limited to immunocompromised cases.…”