Abstract
Delta neutrophil index (DNI) is a novel diagnostic and prognostic biomarker of various infectious or inflammatory conditions. However, data on optimal measurement time are scarce, and no studies have evaluated the potential role of the DNI as a prognostic biomarker of gastrointestinal diseases with diagnostic test accuracy meta-analysis. Core databases were searched. The inclusion criteria were as follows: patients who have gastrointestinal diseases and DNI measurements presenting diagnostic indices for predicting the prognosis, including severity, surgical outcomes, and mortality from gastrointestinal diseases. We identified twelve studies for the systematic review and ten studies for the quantitative analysis. Pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of DNI at the initial admission date were 0.82 (95% confidence interval: 0.78–0.85), 0.75 (0.52–0.89), 0.76 (0.63–0.86), and 10 (3–35), respectively. Meta-regression showed no reasons for heterogeneity and publication bias was not detected. Fagan’s nomogram indicated that the posterior probability of ‘poor prognosis’ was 76% if the test was positive, and ‘no poor prognosis’ was 25% if the test was negative. The DNI can be considered as a reliable initial measurement biomarker for predicting prognosis in patients with gastrointestinal diseases,
Highlights
Gastrointestinal disorders (GI disorders) are associated with substantial morbidity and mortality
We included studies that satisfied the following selection criteria: 1. patients: who have GI diseases; 2. intervention: studies with Delta neutrophil index (DNI) measurements; 3. comparison: none; 4. outcome: diagnostic indices of DNI, such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), accuracy, or diagnostic odds ratio (DOR), which enable an estimation of true positive (TP), false positive (FP), false negative (FN), and true negative (TN) numbers for the prediction of prognosis in GI diseases; 5. study design: not limited; 6. studies of adult subjects; and 7. full-text publications in English
The remaining 72 studies were reviewed through full-text reading. 60 studies were excluded according to the exclusion criteria: not relevant to GI diseases (n = 42), pediatric study (n = 11), abstract only study (n = 2), animal study (n = 2), study protocol (n = 1), and systematic review or meta-analysis (n = 2)
Summary
Gastrointestinal disorders (GI disorders) are associated with substantial morbidity and mortality. The situation in the US is similar as the annual medical expenditure of GI disorders totaled $135.9 billion in 2015 [2,3] This amount is greater than that of many common disorders, including traumatic diseases, cardiovascular diseases, and psychiatric illnesses [2,3]. DNI is a laboratory index which is calculated as the ratio of immature granulocyte numbers to the total neutrophil counts in peripheral circulation [7]. It is calculated by subtracting the fraction of mature polymorphonuclear leukocytes from the sum of myeloperoxidase-reactive cells [7,8]. Our study aimed to provide an evidence of DNI as a prognostic biomarker in GI diseases
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