Moon SooYoon, Park YongBum, Hong Chang-Won, Park Sunghoon, Sim YunSu, Ko Yousang, Park SoYoung
Department of Nephrology, Korea University Guro Hospital, Division of Pulmonary, Allergy and Critical Care Medicine, Seoul 08308, Republic of Korea.
Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea.
J Clin Med. 2025 Mar 15;14(6):2002. doi: 10.3390/jcm14062002.
: The delta neutrophil index (DNI) represents the immature granulocyte fraction and is determined by subtracting the fraction of mature polymorphonuclear leucocytes from the sum of myeloperoxidase-reactive cells. The DNI has been proposed as a useful prognostic marker for sepsis. This study evaluated the clinical utility of DNI as a predictive marker in patients with pneumonia-induced sepsis in the intensive care unit (ICU). : We conducted a retrospective study of pneumonia-induced sepsis in patients who were admitted to the Kangdong Sacred Heart Hospital's medical ICUs from July 2022 to March 2024. The DNI was measured on three consecutive days after ICU admission. The primary outcome of this study was a 28-day mortality. : A total of 227 patients with pneumonia-induced sepsis were included in this study. A 28-day mortality occurred 20.3% of the time in our study. In a univariate analysis, age ( = 0.05), lymphocyte ( = 0.02), DNI 1 ( = 0.01), DNI 2 ( = 0.00), DNI 3 ( = 0.00), and lactic acid ( = 0.00) were significantly associated with 28-day mortality. In a multivariable analysis, lactate (adj. OR: 0.86, 95% CI: 0.78-0.95, = 0.002), and DNI 3 (adj. OR: 0.94, 95% CI: 0.89-0.99, = 0.048) were significantly associated with 28-day mortality. In our study, the most appropriate cut-off values were DNI 1 (7.15), DNI 2 (8.9), and DNI 3 (2.6). Patients with higher DNI 3 (≥2.6) showed higher 28-day mortality than patients with lower DNI 3 values of <2.6 (67.4% vs. 32.6%; < 0.001). However, those aged ≥70 did not show statistically significantly different DNI 1 values between the survivor and non- survivor groups. : The DNI at 72 h after ICU admission is a promising predictive prognostic marker of 28-day mortality in patients with pneumonia-induced sepsis in the ICU. However, the interpretation of the DNI in sepsis patients aged 70 and older on the first day of hospitalization should be approached with caution.
中性粒细胞 delta 指数（DNI）代表未成熟粒细胞比例，通过从髓过氧化物酶反应性细胞总和中减去成熟多形核白细胞比例来确定。DNI 已被提议作为脓毒症的一种有用的预后标志物。本研究评估了 DNI 作为重症监护病房（ICU）中肺炎诱发脓毒症患者预测标志物的临床效用。：我们对 2022 年 7 月至 2024 年 3 月入住江东圣心医院医学 ICU 的肺炎诱发脓毒症患者进行了一项回顾性研究。在入住 ICU 后的连续三天测量 DNI。本研究的主要结局是 28 天死亡率。：本研究共纳入 227 例肺炎诱发脓毒症患者。在我们的研究中，28 天死亡率为 20.3%。在单因素分析中，年龄（P = 0.05）、淋巴细胞（P = 0.02）、DNI 1（P = 0.01）、DNI 2（P = 0.00）、DNI 3（P = 0.00）和乳酸（P = 0.00）与 28 天死亡率显著相关。在多因素分析中，乳酸（校正后比值比：0.86，95%可信区间：0.78 - 0.95，P = 0.002）和 DNI 3（校正后比值比：0.94，95%可信区间：0.89 - 0.99，P = 0.048）与 28 天死亡率显著相关。在我们的研究中，最合适的截断值为 DNI 1（7.15）、DNI 2（8.9）和 DNI 3（2.6）。DNI 3 较高（≥2.6）的患者 28 天死亡率高于 DNI 3 值较低（<2.6）的患者（67.4%对 32.6%；P < 0.001）。然而，年龄≥70 岁的患者在幸存者和非幸存者组之间的 DNI 1 值没有统计学上的显著差异。：入住 ICU 72 小时后的 DNI 是 ICU 中肺炎诱发脓毒症患者 28 天死亡率的一个有前景的预测性预后标志物。然而，对于 70 岁及以上脓毒症患者入院第一天 DNI 的解读应谨慎对待。
