Pyo Jung Yoon, Ha You-Jung, Song Jason Jungsik, Park Yong-Beom, Lee Soo-Kon, Lee Sang-Won
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine.
Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Rheumatology (Oxford). 2017 May 1;56(5):795-801. doi: 10.1093/rheumatology/kew471.
An acute gout attack is often misdiagnosed as cellulitis. Differentiating these two diseases is crucial when deciding treatment strategies. Delta neutrophil index (DNI) represents the difference between leucocyte subfractions that corresponds to the fraction of immature granulocytes and can predict the bacterial infection burden. The aim of this study was to evaluate the potential of DNI as a predictive marker for differentiating an acute gout attack and cellulitis.
We reviewed medical records of 184 patients with an acute gout attack and 183 patients with lower limb cellulitis. DNI was automatically determined by the ADVIA 2120 electronic cell analyser. We used logistic regression to determine independent variables for predicting cellulitis among clinical and laboratory markers. We performed a subgroup analysis among patients without MSU crystal confirmation and among patients with normouricaemia.
Patients with an acute gout attack had lower values of DNI than those with cellulitis (0.6 vs 2.8%; P < 0.001). These results were consistent in patients without MSU confirmation and in patients with normouricaemia (0.5 vs 2.8 and 0.7 vs 2.6%, respectively; P < 0.001 for both). A cut-off value of 1.7% was determined to predict cellulitis. Multivariate analysis showed that DNI was the only independent predictive value for cellulitis (odds ratio 9.699). Similar results were found in patients without MSU confirmation and in patients with normouricaemia (odds ratio 18.763 and 5.215, respectively).
This study showed that DNI was an effective independent marker to differentiate between an acute gout attack and cellulitis at the crucial early phase irrespective of MSU crystal confirmation or serum uric acid concentration.
急性痛风发作常被误诊为蜂窝织炎。在决定治疗策略时，区分这两种疾病至关重要。δ中性粒细胞指数（DNI）代表白细胞亚群之间的差异，该差异对应未成熟粒细胞的比例，并且可以预测细菌感染负担。本研究的目的是评估DNI作为区分急性痛风发作和蜂窝织炎的预测标志物的潜力。
我们回顾了184例急性痛风发作患者和183例下肢蜂窝织炎患者的病历。DNI由ADVIA 2120电子细胞分析仪自动测定。我们使用逻辑回归来确定临床和实验室指标中预测蜂窝织炎的独立变量。我们在未进行MSU晶体确认的患者和血尿酸正常的患者中进行了亚组分析。
急性痛风发作患者的DNI值低于蜂窝织炎患者（0.6%对2.8%；P<0.001）。在未进行MSU确认的患者和血尿酸正常的患者中，这些结果是一致的（分别为0.5%对2.8%和0.7%对2.6%；两者P均<0.001）。确定1.7%的临界值来预测蜂窝织炎。多变量分析表明，DNI是蜂窝织炎的唯一独立预测值（比值比9.699）。在未进行MSU确认的患者和血尿酸正常的患者中发现了类似结果（比值比分别为18.763和5.215）。
本研究表明，无论是否进行MSU晶体确认或血清尿酸浓度如何，DNI都是在关键早期区分急性痛风发作和蜂窝织炎的有效独立标志物。
