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Usefulness of the Delta Neutrophil Index to Predict 30-Day Mortality in Patients with Upper Gastrointestinal Bleeding

 Kong, Taeyoung  ;  In, Sangkook  ;  Park, Yoo Seok  ;  Lee, Hye Sun  ;  Lee, Jong Wook  ;  You, Je Sung  ;  Chung, Hyun Soo  ;  Park, Incheol  ;  Chung, Sung Phil 
 Shock, Vol.48(4) : 427-435, 2017 
Journal Title
Issue Date
Aged ; Female ; Gastrointestinal Hemorrhage/blood* ; Gastrointestinal Hemorrhage/mortality* ; Gastrointestinal Hemorrhage/therapy ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Models, Biological* ; Neutrophils* ; Retrospective Studies ; Time Factors
PURPOSE: The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with systemic inflammation. It is rapidly and easily measured while performing a complete blood count. This study aimed to determine whether the DNI can predict short-term mortality in patients presenting to the emergency department (ED) with upper gastrointestinal hemorrhage (UGIH). METHODS: We retrospectively identified consecutive patients (>18 years old) with UGIH admitted to the ED from January 1, 2015 to February 28, 2016. The diagnosis of UGIH was confirmed using clinical, laboratory, and endoscopic findings. The DNI was determined on each day of hospitalization. The outcome of interest was 30-day mortality. RESULTS: Overall, 432 patients with UGIH met our inclusion criteria. The multivariate Cox regression model demonstrated that higher DNI values on days 0 (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02-1.17; P = 0.012) and 1 (HR, 1.15; 95% CI, 1.06-1.24; P = 0.001) were strong independent predictors of short-term mortality. Further, a DNI >1% at ED admission was associated with an increased risk (HR, 40.9; 95% CI, 20.8-80.5; P < 0.001) of 30-day mortality. The optimal cut-off value for DNI on day 1 was 2.6%; this was associated with an increased hazard of 30-day mortality following UGIH (HR, 7.85; 95% CI, 3.59-17.15; P < 0.001). CONCLUSION: The DNI can be measured rapidly and simply at ED admission without additional cost or time burden. Increased DNI values independently predict 30-day mortality in patients with UGIH.
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
공태영(Kong, Tae Young) ; 박유석(Park, Yoo Seok) ; 박인철(Park, In Cheol) ; 유제성(You, Je Sung) ; 이혜선(Lee, Hye Sun) ; 정성필(Chung, Sung Pil) ; 정현수(Chung, Hyun Soo)
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