Abstract
Delta neutrophil index (DNI) is the fraction of circulating immature granulocytes, which reflects severe bacterial infections and septic condition but has not been studied in urinary tract infection (UTI). Here, we evaluated the value of DNI in predicting acute pyelonephritis (APN) or vesicoureteral reflux (VUR) using the data of 288 patients. Conventional inflammatory markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and DNI were measured. WBC, CRP, ESR and DNI were higher in APN than in lower UTI (p < 0.01). Multiple logistic-regression analyses showed that DNI was a predictive factor for areas of lack of uptake on dimercaptosuccinic acid (DMSA) scans (P < 0.01). The area under the receiver operating characteristic (AUC) was also high for DNI (0.622, 95% CI 0.558–0.687, P < 0.01) as well as for CRP (0.731, 95% CI 0.673–0.789, P < 0.01) for the prediction of DMSA defects. DNI demonstrated the highest area under the ROC curve for diagnosis of VUR (0.620, 95% CI 0.542–0.698, P < 0.01). To the best of our knowledge, this is a first study demonstrating that DNI can be used as a diagnostic marker to distinguish APN from lower UTI and function as a diagnostic marker indicative of VUR compared to other conventional markers.
Highlights
Mortality than WBC or CRP levels in patients with bacterial sepsis[7,8]
This study is the first to show that delta neutrophil index (DNI), which reflects the number of circulating granulocyte precursors in the blood, can be an effective marker to differentiate APN from lower Urinary tract infection (UTI) in young children
UTI can be localized to the bladder, infection can spread to the renal parenchyma and cause APN which is associated with the formation of a renal scar and increased risk of hypertension and chronic kidney disease (CKD)[9,10]
Summary
Mortality than WBC or CRP levels in patients with bacterial sepsis[7,8]. very few validation studies are published and there has yet to be a report on the clinical usefulness of DNI in children with UTIs. We aimed at an evaluation of the usefulness of DNI as an inflammatory marker in infants and young children with febrile UTI with respect to its potential in identification of APN and vesicoureteral reflux
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