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Newly designed delta neutrophil index-to-serum albumin ratio prognosis of early mortality in severe sepsis

 Yoon Jung Hwang  ;  Sung Phil Chung  ;  Yoo Seok Park  ;  Hyun Soo Chung  ;  Hye Sun Lee  ;  Jong Woo Park  ;  Jong Wook Lee  ;  Jung Hwa Hong  ;  Je Sung You  ;  Incheol Park 
 American Journal of Emergency Medicine, Vol.33(11) : 1577-1582, 2015 
Journal Title
 American Journal of Emergency Medicine 
Issue Date
Adult ; Aged ; Biomarkers/blood ; Emergency Service, Hospital ; Female ; Health Status Indicators* ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Neutrophils/metabolism* ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sepsis/blood ; Sepsis/mortality* ; Sepsis/therapy ; Serum Albumin/metabolism*
PURPOSE: We evaluated the ratio of delta neutrophil index (DNI) to albumin (A) in patients receiving early goal-directed therapy (EGDT) to determine the prognostic significance of the DNI/A ratio as a marker of early mortality in critically ill patients with suspected sepsis. METHODS: We retrospectively analyzed records from a prospective EGDT registry in an emergency department (ED) and screened eligible adult patients who were admitted to the ED with severe sepsis and/or septic shock. The new DNI/A ratio was calculated as the DNI value on each hospital day divided by the initial albumin level on ED admission. The clinical outcome was mortality after 28 days. RESULTS: A total of 120 patients receiving EGDT were included in this study. Multivariate Cox proportional-hazard models revealed that higher DNI/A ratios on day 1 (hazard ratio [HR], 1.068; 95% confidence interval [CI], 1.01-1.13; P = .0209) and the peak day (HR, 1.057; 95% CI, 1.001-1.116; P = .0456) were independent risk factors for mortality at 28 days. Our study demonstrated that the increased trend toward 28-day mortality was associated with a DNI/A ratio greater than 8.4 on day 1 (HR, 2.513; 95% CI, 0.950-6.64; P = .0528) and a higher DNI/A ratio (>6.4) on the peak day (average, 4.2 days; HR, 2.953; 95% CI, 1.033-8.441; P < .001) in patients with severe sepsis receiving EGDT. CONCLUSION: The ratio of DNI to serum albumin on ED admission is a promising prognostic marker of 28-day mortality in patients with severe sepsis receiving EGDT.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
박유석(Park, Yoo Seok) ORCID logo https://orcid.org/0000-0003-1543-4664
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
유제성(You, Je Sung) ORCID logo https://orcid.org/0000-0002-2074-6745
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
정성필(Chung, Sung Pil) ORCID logo https://orcid.org/0000-0002-3074-011X
정현수(Chung, Hyun Soo) ORCID logo https://orcid.org/0000-0001-6110-1495
홍정화(Hong, Jung Hwa)
황윤정(Hwang, Yoon Jung) ORCID logo https://orcid.org/0000-0001-7286-7699
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