The delta neutrophil index predicts development of multiple organ dysfunction syndrome and 30-day mortality in trauma patients admitted to an intensive care unit: a retrospective analysis

Taeyoung Kong,Je Sung You,Yoo Seok Park,Jong Wook Lee,Hyun Soo Chung,Sung Phil Chung,Hye Sun Lee,Sinae Kim,Incheol Park

doi:10.1038/s41598-018-35796-4

Abstract

No studies have examined the role of delta neutrophil index (DNI) reflecting on immature granulocytes in determining the severity of multiple organ dysfunction (MODS) and short-term mortality. This study investigated the utility of the automatically calculated DNI as a prognostic marker of severity in trauma patients who were admitted to an intensive care unit (ICU). We retrospectively analysed prospective data of eligible patients. We investigated 366 patients. On multivariable logistic regression analysis, higher DNI values at 12 h (odds ratio [OR], 1.079; 95% confidence interval [CI]: 1.037–1.123; p < 0.001) and 24 h were strong independent predictors of MODS development. Multivariable Cox regression analysis revealed that increased DNI at 12 h (hazard ratio [HR], 1.051; 95% CI, 1.024–1.079; p < 0.001) was a strong independent predictor of short-term mortality. The increased predictability of MODS after trauma was closely associated with a DNI > 3.25% at 12 h (OR, 12.7; 95% CI: 6.12–26.35; p < 0.001). A cut-off of >5.3% at 12 h was significantly associated with an increased risk of 30-day mortality (HR, 18.111; 95% CI, 6.988–46.935; p < 0.001). The DNI is suitable for rapid and simple estimation of the severity of traumatic injury using an automated haematologic analyser without additional cost or time.

Highlights

No studies have examined the role of delta neutrophil index (DNI) reflecting on immature granulocytes in determining the severity of multiple organ dysfunction (MODS) and short-term mortality
The DNI reflects the proportion of circulating immature granulocytes and is calculated as the difference between the leukocyte differentials measured in the myeloperoxidase channel and the differentials detected in the lobularity channel[8,9]
To the best of our knowledge, no study has assessed the ability of serial DNI measurements to predict the clinical severities of MODS and short-term mortality, nor have any DNI cut-off values that predict the severity of trauma patients admitted to an intensive care unit (ICU) been derived

Summary

Introduction

No studies have examined the role of delta neutrophil index (DNI) reflecting on immature granulocytes in determining the severity of multiple organ dysfunction (MODS) and short-term mortality. This study investigated the utility of the automatically calculated DNI as a prognostic marker of severity in trauma patients who were admitted to an intensive care unit (ICU). In patients with severe traumatic injuries such as haemorrhage and damage to organs and tissues, the release of immature granulocytes into circulation may contribute to the failure to protect against infection and the risk of MOF21,22. To the best of our knowledge, no study has assessed the ability of serial DNI measurements to predict the clinical severities of MODS and short-term mortality, nor have any DNI cut-off values that predict the severity of trauma patients admitted to an ICU been derived. In this study, we investigated the clinical utility of the DNI as a predictor of severity in trauma patients admitted to an ICU

Methods

Results

Conclusion