Delta neutrophil index: in search of an early indicator of sepsis.

Abstract

Sepsis is a significant cause of morbidity and mortality worldwide. Current clinical practice, however, lacks reliable diagnostic indicators for it and its prognosis. The present study aimed to investigate the efficacy of delta neutrophil index (DNI), which reflects the proportion of circulating immature granulocytes, in predicting infections and sepsis. A prospective non-interventional single-center clinical follow-up study was performed in a Bulgarian ICU between January 1, 2017 and May 31, 2018. We analyzed adult patients: 45 patients met the sepsis criteria, as defined in SEPSIS-3, whereas 37 were infected patients fulfilling no criteria of sepsis. Logistic regression and Roc-curve analysis were used to evaluate the severity and prognostic value of DNI as a prediction marker in critically ill septic patients. The results have shown that at DNI values of 1.4 there is 73% sensitivity and 87% specificity (AUC 0.764, 95% CI 0.650-0.878, p=0.0001) to assume the presence of sepsis. Additionally, DNI was significantly associated with the severity of the condition of patients, the organ dysfunction and the IL-8 marker. DNI may serve as a useful marker for early diagnosis of sepsis and could support decision making process regarding its treatment at an early stage of a disease development.