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

 Hyunchul Kim  ;  Taeyoung Kong  ;  Sung Phil Chung  ;  Jung Hwa Hong  ;  Jong Wook Lee  ;  Youngseon Joo  ;  Dong Ryul Ko  ;  Je Sung You  ;  Incheol Park 
 Shock, Vol.47(3) : 303-312, 2017 
Journal Title
Issue Date
Aged ; Biomarkers/blood* ; Cholangitis/blood* ; Cholangitis/pathology* ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Neutrophils/physiology* ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors
Acute cholangitis ; admission ; biliary tract ; delta neutrophil index ; immature granulocyte ; mortality ; shock
PURPOSE: Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analyzers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis. METHODS: We retrospectively analyzed patients initially diagnosed with acute cholangitis at emergency department admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality. RESULTS: We included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053-1.153; P < 0.001), day 1 (HR: 1.069; 95% CI: 1.018-1.122; P = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053-1.186; P < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI > 4.9% at admission (HR: 5.632; 95% CI: 1.977-16.045; P = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666-37.302; P < 0.001) and higher DNI ( > 2.5%) on day 2 (HR, 16.942; 95% CI: 2.15-133.496; P = 0.007) were associated with increased 28-day mortality. CONCLUSION: Higher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
고동률(Ko, Dong Ryul) ORCID logo https://orcid.org/0000-0002-3098-2784
공태영(Kong, Tae Young) ORCID logo https://orcid.org/0000-0002-4182-7245
김현철(Kim, Hyun Chul)
박인철(Park, In Cheol) ORCID logo https://orcid.org/0000-0001-7033-766X
유제성(You, Je Sung) ORCID logo https://orcid.org/0000-0002-2074-6745
정성필(Chung, Sung Pil) ORCID logo https://orcid.org/0000-0002-3074-011X
주영선(Joo, Young Seon)
홍정화(Hong, Jung Hwa)
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