Han In Mi, Yoon Chang-Yun, Shin Dong Ho, Kee Youn Kyung, Han Seung Gyu, Kwon Young Eun, Park Kyoung Sook, Lee Mi Jung, Oh Hyung Jung, Park Jung Tak, Han Seung Hyeok, Kang Shin-Wook, Yoo Tae-Hyun
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea.
BMC Nephrol. 2017 Mar 20;18(1):94. doi: 10.1186/s12882-017-0507-8.
Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes in acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of this study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI) patients treated with continuous renal replacement therapy (CRRT).
This is a retrospective analysis of consecutively CRRT treated patients. We enrolled 286 S-AKI patients who underwent CRRT and divided them into three groups based on the tertiles of DNI at CRRT initiation (high, DNI > 12.0%; intermediate, 3.6-12.0%; low, < 3.6%). Patient survival was estimated with the Kaplan-Meier method and Cox proportional hazards models to determine the effect of DNI on the mortality of S-AKI patients.
Patients in the highest tertile of DNI showed higher Acute Physiology and Chronic Health Evaluation II score (highest tertile, 27.9 ± 7.0; lowest tertile, 24.6 ± 8.3; P = 0.003) and Sequential Organ Failure Assessment score (highest tertile, 14.1 ± 3.0; lowest tertile, 12.1 ± 4.0; P = 0.001). The 28-day mortality rate was significantly higher in the highest tertile group than in the lower two tertile groups (P < 0.001). In the multiple Cox proportional hazard model, DNI was an independent predictor for mortality after adjusting multiple confounding factors (hazard ratio, 1.010; 95% confidence interval, 1.001-1.019; P = 0.036).
This study suggests that DNI is independently associated with mortality of S-AKI patients on CRRT.
δ中性粒细胞指数（DNI）代表急性感染时循环中未成熟粒细胞比例升高，据报道是预测脓毒症患者死亡率的有用标志物。本研究的目的是评估DNI在预测接受持续肾脏替代治疗（CRRT）的脓毒症急性肾损伤（S-AKI）患者死亡率方面的预后价值。
这是一项对连续接受CRRT治疗患者的回顾性分析。我们纳入了286例接受CRRT的S-AKI患者，并根据CRRT开始时DNI的三分位数将他们分为三组（高，DNI＞12.0%；中，3.6%-12.0%；低，＜3.6%）。采用Kaplan-Meier法和Cox比例风险模型估计患者生存率，以确定DNI对S-AKI患者死亡率的影响。
DNI最高三分位数组的患者急性生理与慢性健康状况评分II（最高三分位数组，27.9±7.0；最低三分位数组，24.6±8.3；P=0.003）和序贯器官衰竭评估评分（最高三分位数组，14.1±3.0；最低三分位数组，12.1±4.0；P=0.001）更高。最高三分位数组的28天死亡率显著高于较低的两个三分位数组（P＜0.001）。在多因素Cox比例风险模型中，调整多个混杂因素后，DNI是死亡率的独立预测因素（风险比，1.010；95%置信区间，1.001-1.019；P=0.036）。
本研究表明，DNI与接受CRRT的S-AKI患者的死亡率独立相关。
