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Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis

Authors
 Byung Hoon Park  ;  Young Ae Kang  ;  Moo Suk Park  ;  Won Jai Jung  ;  Su Hwan Lee  ;  Sang Kook Lee  ;  Song Yee Kim  ;  Se Kyu Kim  ;  Joon Chang  ;  Ji Ye Jung  ;  Young Sam Kim 
Citation
 BMC INFECTIOUS DISEASES, Vol.11 : 299, 2011 
Journal Title
BMC INFECTIOUS DISEASES
Issue Date
2011
MeSH
Adult ; Aged ; Critical Illness ; Female ; Flow Cytometry/methods ; Humans ; Intensive Care Units ; Leukocyte Count ; Male ; Middle Aged ; Neutrophils/immunology* ; Sensitivity and Specificity ; Sepsis/diagnosis* ; Sepsis/pathology* ; Severity of Illness Index*
Keywords
Severe Sepsis ; Systemic Inflammatory Response Syndrome ; Sequential Organ Failure Assessment ; Disseminate Intravascular Coagulation ; Absolute Neutrophil Count
Abstract
BACKGROUND: The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.

METHODS: One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.

RESULTS: Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.

CONCLUSIONS: DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.
Files in This Item:
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DOI
10.1186/1471-2334-11-299
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Se Kyu(김세규)
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Park, Byung Hoon(박병훈)
Lee, Sang Kook(이상국)
Lee, Su Hwan(이수환) ORCID logo https://orcid.org/0000-0002-3487-2574
Chang, Joon(장준) ORCID logo https://orcid.org/0000-0003-4542-6841
Jung, Won Jai(정원재)
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/95020
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