Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Department of Surgery, Saidabad Clinic, Dhaka, Bangladesh.
PLoS One. 2020 Mar 23;15(3):e0230149. doi: 10.1371/journal.pone.0230149. eCollection 2020.
Delta neutrophil index (DNI) can be used as a biomarker for infection to predict patient outcomes. We aimed to investigate the relationship between DNI and clinical outcomes in trauma patients who underwent abdominal surgery.
We retrospectively analyzed injured patients who underwent emergent abdominal surgery in the regional trauma center of Wonju Severance Christian Hospital between March 2016 and May 2018. Patient characteristics, operation type, preoperative and postoperative laboratory findings, and clinical outcomes were evaluated. Logistic regression analysis was performed for risk factors associated with mortality.
Overall, 169 patients (mean age, 53.8 years; 66.3% male) were enrolled in this study, of which 19 (11.2%) died. The median injury severity score (ISS) was 12. The non-survivors had a significantly higher ISS [25(9-50) vs. 10(1-50), p<0.001] and serum lactate level (9.00±4.10 vs. 3.04±2.23, p<0.001) and more frequent shock (63.2% vs 23.3%, p<0.001) and solid organ injury (52.6% vs. 25.3%, p = 0.013) than the survivors. There were significant differences in postoperative DNI between the two groups (p<0.009 immediate post-operation, p = 0.001 on postoperative day 1 [POD1], and p = 0.013 on POD2). Logistic regression analysis showed that the independent factors associated with mortality were postoperative lactate level (odds ratio [OR] 1.926, 95% confidence interval [CI] 1.101-3.089, p = 0.007), postoperative sequential organ failure assessment score (OR 1.593, 95% CI 1.160-2.187, p = 0.004), and DNI on POD1 (OR 1.118, 95% CI 1.028-1.215, p = 0.009). The receiver operating characteristics curve demonstrated that the area under the curve of DNI on POD1 was 0.887 (cut-off level: 7.1%, sensitivity 85.7%, and specificity 84.4%).
Postoperative DNI may be a useful biomarker to predict mortality in trauma patients who underwent emergent abdominal surgery.
中性粒细胞 delta 指数（DNI）可用作感染的生物标志物，以预测患者的预后。我们旨在探讨创伤患者腹部手术后 DNI 与临床结局的关系。
我们回顾性分析了 2016 年 3 月至 2018 年 5 月在沃努基督医院地区创伤中心接受紧急腹部手术的创伤患者。评估患者特征、手术类型、术前和术后实验室检查结果以及临床结局。对与死亡率相关的危险因素进行 logistic 回归分析。
总体而言，本研究共纳入 169 例患者（平均年龄 53.8 岁；66.3%为男性），其中 19 例（11.2%）死亡。中位损伤严重程度评分（ISS）为 12。非幸存者的 ISS 显著更高[25（9-50）比 10（1-50），p<0.001]，血清乳酸水平更高[9.00±4.10 比 3.04±2.23，p<0.001]，休克更频繁[63.2%比 23.3%，p<0.001]，实体器官损伤更常见[52.6%比 25.3%，p=0.013]。两组术后 DNI 差异有统计学意义（p<0.009 即刻术后，p=0.001 术后第 1 天[POD1]，p=0.013 术后第 2 天[POD2]）。Logistic 回归分析显示，与死亡率相关的独立因素是术后乳酸水平（优势比[OR]1.926，95%置信区间[CI]1.101-3.089，p=0.007）、术后序贯器官衰竭评估评分（OR 1.593，95%CI 1.160-2.187，p=0.004）和 POD1 的 DNI（OR 1.118，95%CI 1.028-1.215，p=0.009）。受试者工作特征曲线表明，POD1 的 DNI 曲线下面积为 0.887（截断值：7.1%，灵敏度 85.7%，特异性 84.4%）。
术后 DNI 可能是预测创伤患者接受紧急腹部手术后死亡率的有用生物标志物。
