Cha Yong Sung, Lee Kang Hyun, Lee Seok Jeong, Kwon Ho Chul, Lee Jong Wook, Kim Hyung Il, Kim Oh Hyun, Cha Kyoung-Chul, Kim Hyun, Hwang Sung Oh
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Clin Exp Emerg Med. 2018 Jun;5(2):76-83. doi: 10.15441/ceem.16.195. Epub 2018 Jun 29.
Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)-a new indicator for immature granulocytes-for DIC diagnosis.
This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite.
Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P<0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P<0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI's receiver operating characteristic curve was 0.724.
DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.
在临床上，消耗性凝血病，如弥散性血管内凝血（DIC），是常见的毒蛇咬伤并发症中最重要的一种，因为这种情况会带来严重的出血风险。我们评估了δ中性粒细胞指数（DNI）——一种未成熟粒细胞的新指标——对DIC诊断的预测价值。
这项回顾性观察研究连续评估了超过51个月的成年毒蛇咬伤患者。患者被分为非DIC组和DIC组。在蛇咬伤后24小时内测量DNI值。
30名患者（26.3%）发生了DIC。DIC组的初始DNI中位数显著高于非DIC组（0%对0.2%，P<0.001）。当将DIC组分为早期和晚期组（分别为蛇咬伤后24小时内和超过24小时）时，前者的DNI显著高于后者和非DIC组。晚期DIC组的DNI显著高于非DIC组。此外，DNI与DIC评分呈正相关（r=0.548，P<0.001）。初始DNI（比值比，4.449；95%置信区间，1.738至11.388；P=0.002）是早期DIC的预测指标。基于初始DNI的受试者工作特征曲线下面积为0.724。
DIC组的DNI值显著更高。此外，DNI是急诊科毒蛇咬伤患者DIC发生的早期预测指标。
