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Clinical significance of delta neutrophil index in the differential diagnosis between septic arthritis and acute gout attack within 24 hours after hospitalization

Authors
 Jung Yoon Pyo  ;  Dae Sik Kim  ;  Seung Min Jung  ;  Jason Jungsik Song  ;  Yong-Beom Park  ;  Sang-Won Lee 
Citation
 Medicine, Vol.96(30) : e7431, 2017 
Journal Title
 Medicine 
ISSN
 0025-7974 
Issue Date
2017
MeSH
Aged ; Arthritis, Infectious/blood ; Arthritis, Infectious/therapy ; Biomarkers/blood ; Diagnosis, Differential ; Female ; Gout/blood ; Gout/therapy ; Hospitalization ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neutrophils ; Odds Ratio ; Time Factors ; Uric Acid/blood
Abstract
The most important differential diagnoses of acute monoarticular arthritis are septic arthritis and acute gout attack. Identifying infection is crucial in preventing the devastating outcome of septic arthritis. The delta neutrophil index (DNI) is a value that corresponds to the fraction of circulating immature granulocytes. As DNI reflects the burden of infection, we evaluated this index as a differentiating marker between septic arthritis and acute gout attack.The medical records of 149 patients with septic arthritis and 194 patients with acute gout attack were reviewed. A specific cell analyzer, ADVIA 2120, was used to measure DNI. Clinical and laboratory markers associated with predicting septic arthritis were assessed by using logistic regression.Patients with septic arthritis showed higher levels of DNI than those with acute gout attack (3.3 vs 0.6%, P < .001). Similar results were observed in patients without monosodium urate (MSU) crystal confirmation or those with normouricemia (3.3 vs 0.5 and 3.1 vs 0.7%, respectively; P < .001 for both). A DNI level of 1.9% was determined as the cutoff value for predicting septic arthritis. In the multivariate analysis, DNI was the most powerful independent value for predicting septic arthritis (odds ratio 14.003).This study showed the possibility of using DNI as a differentiating marker between septic arthritis and acute gout attack at the crucial early phase. DNI showed its relevance regardless of confirmation of MSU crystal deposition or serum level of uric acid.
Files in This Item:
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DOI
10.1097/MD.0000000000007431
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
박용범(Park, Yong Beom)
송정식(Song, Jungsik Jason) ORCID logo https://orcid.org/0000-0003-0662-7704
이상원(Lee, Sang Won) ORCID logo https://orcid.org/0000-0002-8038-3341
정승민(Jung, Seung Min ) ORCID logo https://orcid.org/0000-0003-3465-2181
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160416
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