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Open Access Highly Accessed Research article

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

Byung Hoon Park1, Young Ae Kang1, Moo Suk Park12, Won Jai Jung1, Su Hwan Lee1, Sang Kook Lee1, Song Yee Kim1, Se Kyu Kim12, Joon Chang12, Ji Ye Jung1 and Young Sam Kim12*

Author Affiliations

1 Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Seoul, Korea

2 The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea

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BMC Infectious Diseases 2011, 11:299  doi:10.1186/1471-2334-11-299

Published: 1 November 2011

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.