Usefulness of the delta neutrophil index to predict 30-day mortality in patients with ST segment elevation myocardial infarction

Taeyoung Kong,Yoo Seok Park,Jong Wook Lee,Jung Hwa Hong,Sung Phil Chung,Je Sung You,Hye Sun Lee,Incheol Park,Tae Hoon Kim

doi:10.1038/s41598-017-15878-5

Abstract

This study aimed to evaluate the association between the delta neutrophil index (DNI), which reflects immature granulocytes, and the severity of ST-elevation myocardial infarction (STEMI), as well as to determine the significance of the DNI as a prognostic marker for early mortality and other clinical outcomes in patients with STEMI who underwent reperfusion. This retrospective, observational cohort study was conducted using patients prospectively integrated in a critical pathway program for STEMI. We included 842 patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI). Higher DNI values at time-I (within 2 h of pPCI; hazard ratio [HR], 1.075; 95% confidence interval [CI]: 1.046–1.108; p < 0.001) and time-24 (24 h after admission; HR, 1.066; 95% CI: 1.045–1.086; p < 0.001) were significant independent risk factors for 30-day mortality. Specifically, DNI values >2.5% at time-I (HR, 13.643; 95% CI: 8.13–22.897; p < 0.001) and > 2.9% at time-24 (HR, 12.752; 95% CI: 7.308–22.252; p < 0.001) associated with increased risks of 30-day mortality. In conclusion, an increased DNI value, which reflects the proportion of circulating immature granulocytes in the blood, was found to be an independent predictor of 30-day mortality and poor clinical outcomes in patients with acute STEMI post-pPCI.

Highlights

Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity worldwide, causing more than 150,000 deaths in the USA each year[1,2]
An intense inflammatory response is activated in the early stage of cardiac ischaemic injury; this contributes significantly to ventricular remodelling after AMI3
Tamhane et al demonstrated that neutrophilia >65% in patients with ST-elevation myocardial infarction (STEMI) reflected worse angiographic outcomes, large infarct size, and increased risk of short-term mortality[16]

Summary

Introduction

Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity worldwide, causing more than 150,000 deaths in the USA each year[1,2]. Despite recent improvements in critical care medicine, patients with ST-segment elevation myocardial infarction (STEMI) on the presenting electrocardiogram (ECG) remain at increased risk of mortality and serious morbidity if they survive the initial ischaemic event[3]. Many studies have attempted to develop cardiac-specific markers or risk scoring systems to identify patients at increased risk and to provide prognostic information[5]. The roles of inflammatory markers for severity assessment in the early stage of STEMI have been attracting interest. Despite experimental and clinical evidence of the associations between inflammation and adverse outcomes, no specific inflammatory biomarkers are currently routinely used in the management of patients with STEMI3,9. We evaluated the significance of the DNI as a prognostic marker of early mortality in patients with STEMI who underwent pPCI. To the best of our knowledge, this is the first study to evaluate the association between the DNI and the severity of STEMI in the clinical setting

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Conclusion