Abstract
We performed a meta-analysis to seek evidence for the usefulness of the delta neutrophil index (DNI) as a prognostic blood biomarker for mortality in the early stage of sepsis in adults. A literature search was performed using criteria set forth in a predefined protocol. Studies of adults with sepsis that provided a DNI measurement and that had mortality as the outcome, were included. Review articles, editorials, and non-human studies were excluded. The methodological quality of identified studies was assessed independently by two authors using the Quality in Prognosis Studies (QUIPS) tool. A total of 1,822 patients from eleven studies were ultimately included. Standardized mean differences between non-survivors and survivors were compared. An elevated DNI was associated with mortality in patients with sepsis (standardized mean difference [SMD] 1.22; 95% confidence interval 0.73–1.71; I2 = 91%). After excluding two studies—one that included paediatric patients and one with a disproportionately low mortality rate—heterogeneity was minimized (SMD 0.74, 95% confidence interval 0.53–0.94; I2 = 43%). Overall, the findings suggest that high DNI values are associated with mortality in septic patients.
Highlights
Sepsis is a rapidly progressive, life-threatening disease
The delta neutrophil index (DNI) is the immature granulocyte fraction provided by a blood cell analyser; it is determined by subtracting the fraction of mature polymorphonuclear leukocytes from the sum of myeloperoxidase-reactive cells and reflects the number of immature neutrophils as a blood biomarker
This systematic review and meta-analysis is the first to demonstrate that the DNI has prognostic value in adults with sepsis: High DNI values tended to be associated with mortality in septic patients
Summary
Sepsis is a rapidly progressive, life-threatening disease. Accurate and expeditious assessment of sepsis is important for early administration of antibiotics and removal of the source of infection[1,2]. The increase in the number of circulating immature granulocyte is referred to as ‘a left shift’, defined as an elevated immature/total granulocyte ratio or an elevated neutrophil band count[12,13] In sepsis, this reflects severity and aggravation of the disease course[14,15]. The delta neutrophil index (DNI) is the immature granulocyte fraction provided by a blood cell analyser; it is determined by subtracting the fraction of mature polymorphonuclear leukocytes from the sum of myeloperoxidase-reactive cells and reflects the number of immature neutrophils as a blood biomarker This index is calculated by differentiating two granulocyte measurements; one measured using the cytochemical myeloperoxidase reaction and the other by the nuclear lobularity channel[18]. This systematic review aimed to seek evidence for the usefulness of the DNI as a prognostic blood biomarker of mortality in patients in the early stage of sepsis
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