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

BMC Infectious Diseases

Research Article

Song Yee Kim¹  Byung Hoon Park¹  Young Ae Kang¹  Won Jai Jung¹  Ji Ye Jung¹  Sang Kook Lee¹  Su Hwan Lee¹  Joon Chang²  Se Kyu Kim²  Young Sam Kim²  Moo Suk Park² 

[1] Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Seoul, Republic of Korea;Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Seoul, Republic of Korea;The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea;

关键词: Severe Sepsis;    Systemic Inflammatory Response Syndrome;    Sequential Organ Failure Assessment;    Disseminate Intravascular Coagulation;    Absolute Neutrophil Count;   

DOI  :  10.1186/1471-2334-11-299

 received in 2011-08-07, accepted in 2011-11-01,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsOne 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.ResultsForty 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.ConclusionsDNI 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.

【 授权许可】

Unknown   
© Park et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.