Lim Tae Seop, Kim Beom Kyung, Lee Jong Wook, Lee Young Ki, Chang Sooyun, Kim Seung Up, Kim Do Young, Ahn Sang Hoon, Han Kwang-Hyub, Chon Chae Yoon, Park Jun Yong
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea ; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea ; Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea.
PLoS One. 2014 Jan 23;9(1):e86884. doi: 10.1371/journal.pone.0086884. eCollection 2014.
Spontaneous bacterial peritonitis (SBP) is a common and life-threatening infection in patients with advanced cirrhosis. The prognostic value of a novel marker, the delta neutrophil index (DNI), was investigated relative to mortality in patients with SBP.
MATERIALS & METHODS: Seventy-five patients with SBP were studied from April 2010 to May 2012. DNI at initial diagnosis of SBP was determined and compared with 30-day mortality rates.
Of the patients, 87.7% were men, and the median age of all patients was 59.0 yrs. The area under the receiver-operating characteristic (ROC) curve of DNI for 30-day mortality was 0.701 (95% confidence interval [CI], 0.553-0.849; p = 0.009), which was higher than that of C-reactive protein (0.640, 95% CI, 0.494-0.786; p = 0.076) or the model for end-stage liver disease score (0.592, 95% CI, 0.436-0.748; p = 0.235). From the ROC curve, with the sum of sensitivity and specificity, the cutoff value of DNI was determined to be 5.7%. In the high-DNI group (DNI ≥5.7%), septic shock and 30-day mortality were more prevalent compared with the low-DNI group (84.2% vs. 48.2%, p = 0.007; 57.9% vs. 14.3%, p<0.001, respectively). Patients with an elevated DNI had a higher risk of 30-day mortality compared with those with a low DNI (4.225, 95% CI, 1.631-10.949; p = 0.003).
A higher DNI at the time of SBP diagnosis is an independent predictor of 30-day mortality in patients with SBP.
自发性细菌性腹膜炎（SBP）是晚期肝硬化患者常见的、危及生命的感染。研究了一种新型标志物——δ中性粒细胞指数（DNI）相对于SBP患者死亡率的预后价值。
对2010年4月至2012年5月期间的75例SBP患者进行研究。测定SBP初诊时的DNI，并与30天死亡率进行比较。
患者中87.7%为男性，所有患者的中位年龄为59.0岁。DNI预测30天死亡率的受试者工作特征（ROC）曲线下面积为0.701（95%置信区间[CI]，0.553 - 0.849；p = 0.009），高于C反应蛋白（0.640，95% CI，0.494 - 0.786；p = 0.076）或终末期肝病模型评分（0.592，95% CI，0.436 - 0.748；p = 0.235）。根据ROC曲线，结合敏感度和特异度之和，确定DNI的截断值为5.7%。与低DNI组相比，高DNI组（DNI≥5.7%）的感染性休克和30天死亡率更为普遍（分别为84.2%对48.2%，p = 0.007；57.9%对14.3%，p<0.001）。与低DNI患者相比，DNI升高的患者30天死亡风险更高（4.225，95% CI，1.631 - 10.949；p = 0.003）。
SBP诊断时较高的DNI是SBP患者30天死亡率的独立预测指标。
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