Kim Hyunchul, Kong Taeyoung, Chung Sung Phil, Hong Jung Hwa, Lee Jong Wook, Joo Youngseon, Ko Dong Ryul, You Je Sung, Park Incheol
*Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea †Department of Health Insurance Research, National Health Insurance Service Ilsan Hospital, Gayang, Republic of Korea ‡Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Republic of Korea §Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
Shock. 2017 Mar;47(3):303-312. doi: 10.1097/SHK.0000000000000722.
Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analyzers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis.
We retrospectively analyzed patients initially diagnosed with acute cholangitis at emergency department admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality.
We included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053-1.153; P < 0.001), day 1 (HR: 1.069; 95% CI: 1.018-1.122; P = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053-1.186; P < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI > 4.9% at admission (HR: 5.632; 95% CI: 1.977-16.045; P = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666-37.302; P < 0.001) and higher DNI ( > 2.5%) on day 2 (HR, 16.942; 95% CI: 2.15-133.496; P = 0.007) were associated with increased 28-day mortality.
Higher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.
近期的技术进步使得使用特定的自动血细胞分析仪能够分析反映循环中未成熟粒细胞比例的δ中性粒细胞指数（DNI）。我们评估了DNI作为急性胆管炎患者早期严重程度预后标志物的意义。
我们回顾性分析了在设定时间段内急诊科入院时最初诊断为急性胆管炎并随后确诊的患者。在住院的每一天测定DNI。临床结局为需要血管升压药/正性肌力药的休克发生率和28天死亡率。
我们纳入了461例符合纳入标准的患者。根据多变量Cox比例风险模型，入院时较高的DNI（风险比[HR]：1.102；95%置信区间[CI]：1.053 - 1.153；P＜0.001）、第1天（HR：1.069；95%CI：1.018 - 1.122；P = 0.008）和第2天（HR：1.118；95%CI：1.053 - 1.186；P＜0.001）是28天死亡率的显著危险因素。在急性胆管炎患者中，入院时DNI＞4.9%（HR：5.632；95%CI：1.977 - 16.045；P = 0.001）、第1天（HR，9.973；95%CI：2.666 - 37.302；P＜0.001）以及第2天较高的DNI（＞2.5%）（HR，16.942；95%CI：2.15 - 133.496；P = 0.007）与28天死亡率增加相关。
较高的DNI水平是急性胆管炎患者血流动力学不稳定和28天死亡率的预测标志物。DNI预测血流动力学不稳定和28天死亡率的准确性优于其他参数。
