Delta Neutrophil Index Values Research Articles

Delta Neutrophil Index and C-Reactive Protein as Predictors of Mortality in Early Onset Neonatal Sepsis at Dr. Moewardi Hospital

Background: Neonatal sepsis is an infection disease in newborns that still be a major problem in developing countries such as Indonesia. Early onset sepsis has higher mortality and morbidity. A simple and applicable biomarkers are needed to predict mortality in early onset neonatal sepsis. This study aimed to investigate whether Delta Neutrophil Index (DNI) and C-Reactive Protein (CRP) can be used as predictors of mortality in early onset neonatal sepsis. Subjects and Method: A cohort study that was conducted at neonatal HCU and NICU at Dr. Moewardi Hospital from March to June 2023. Total of 30 neonates aged 0-72 hours which met the inclusion criteria and became research subjects. The dependent variable was the mortality of neonatal sepsis. The independent variable were levels of DNI and CRP values. The instruments were flowcytometry to measure levels of DNI and Enzyme Linked Immunoassay (ELISA) for determining CRP values. Data were analyzed using SPSS 25.0. Bivariate analysis was using Chi square and Fisher exact followed by multivariate analysis using logistic regression with p<0.05. Results: Thirty early onset septic neonates were included in study, of whom 17 children died and 13 children survived. Both DNI and CRP had significant correlation with mortality of neonatal sepsis (p<0.001). The DNI cut-off value of ≥ 5.4% (OR = 10.83; 95% CI 1.96 to 59.63; p = 0.004) can predict mortality in early onset neonatal sepsis. The CRP cut-off values of ≥5.75 mg/L (OR = 15.56; 95%CI 2.59 to 93.57; p = 0.001) could predict early onset neonatal sepsis mortality. Other factors such as gender, gestational age, birth weight and blood culture couldn’t be used as predictors of mortality in neonatal sepsis, with p value >0.05. Conclusion: DNI and CRP could be used as predictors of mortality in early onset neonatal sepsis. Keywords: clean and healthy living behavior, diarrhea, toddlers. Correspondence: Almira Muthia Deaneva. Department of Pediatrics, Sebelas Maret University/Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. Kolonel Sutarto Street No. 132, Surakarta, Indonesia. email: almiradea@gmail.com Phone: 081215822020.

In premature rupture of membranes, maternal serum delta neutrophil index may be a predictive factor for histological chorioamnionitis and affect fetal inflammatory markers: A retrospective cross-sectional study.

We aimed to investigate the predictive value of delta neutrophil index (DNI) for histological choriomanionitis (HCAM) and the effect of maternal inflammatory markers on neonatal outcomes and fetal inflammatory parameters. In this retrospective cross-sectional study, 68 pregnant women without HCAM (group 1) and 46 pregnant women diagnosed with HCAM (group 2) were divided into two groups. Demographic stories of the groups; maternal hematological parameters; maternal DNI and systemic inflammatory index (SII) values; outcomes of newborns; fetal inflammatory markers were recorded and compared between groups. Maternal DNI, and SII levels were significantly higher in group 2 (p value<.05 for all). Admission to the neonatal unit (NICU) was higher in group 2 than in group 1 (p=.0001). We found that fetal inflammatory markers were significantly higher in group 2 (p values .001 for CRP, .0001 for DNI, and .002 for leukocyte). Maternal DNI was determined to be significantly diagnostic at a value of ≥1.3 in HCAM (p=.001). We observed that SII had a significant predictive value of 953036.6 (p=.019) for NICU admission. There is also a positive correlation between fetal inflammatory markers and maternal inflammatory markers. We found that maternal inflammatory markers are high in HCAM, maternal DNI can predict patients who will develop HCAM, maternal SII value can predict NICU admission, fetal inflammatory markers are high in HCAM, and these markers are affected by maternal inflammatory markers.

Elevated Delta Neutrophil Index (DNI) as a Predictor of Systemic Inflammatory Response Syndrome (SIRS) In Patients with Generalized Peritonitis at Prof Dr. I.G.N.G. Ngoerah Hospital, Denpasar

Background: Generalized peritonitis is an emergency case in the field of surgery. Which includes an inflammatory process in the peritoneum. Systemic inflammatory response syndrome (SIRS) is a defense response to a stressor. Delta Neutrophil Index (DNI) is a parameter that reflects the ratio of infection and inflammation. This study examines the role of DNI as a predictor of SIRS in generalized peritonitis patients at Prof. Dr. IGNG Ngoerah General Hospital. Method: Cross-sectional analytic observational research. Data collection was from July 2022 to October 2022. Patients diagnosed with generalized peritonitis were taken for blood samples. The DNI examination was carried out at the Surya Husadha Hospital Laboratory. Samples were excluded if they suffered from immunodeficiency diseases, autoimmune diseases and refused to participate. The DNI value is determined by the cut-off point on the ROC curve. Bivariate analysis using Chi square test and multivariate analysis using logistic regression test. The p value &lt;0.05 indicates a significant result. Result: This study involved 55 respondents with 41 positive SIRS respondents and 14 negative SIRS respondents. ROC curve analysis showed the DNI value with a cut-off point of 8.9 (sensitivity 85.4% and specificity 85.7%). Bivariate analysis of the DNI 8.9 with the incidence of SIRS obtained RR 3 (p = 0.000; 95% C1 1.11- 6.90). Multivariate analysis of DNI values with the incidence of SIRS showed a significant relationship (p = 0.000). Conclusion: DNI value of 8.9 is an excellent predictor of SIRS in patients with generalized peritonitis.

The role of delta neutrophil index in early identification of severe acute pancreatitis in adult patients: a prospective diagnostic accuracy study

Objective: The primary outcome of this study is to evaluate the diagnostic performance of the initial delta neutrophil index (DNI) for early identification of severe acute pancreatitis (SAP). Material and Methods: All diagnoses and definitions were made according to the revised Atlanta classification. DNI (delta neutrophil index) was measured automatically using a hematology analyzer. The study included patients aged 18 years and older who were admitted with abdominal pain consistent with acute pancreatitis. The exclusion criteria encompassed patients with a known diagnosis of pancreatic malignancy, iatrogenic endoscopic pancreatitis, those presenting with abdominal trauma, and those experiencing exacerbation of chronic pancreatitis. Results: The median DNI for patients who developed SAP was 0.5 (0.29-1.1), while for non-severe patients, it was 0.2 (0.1-0.41). The difference between the two outcome groups was found to be statistically significant (p&lt;0.001). The area under the curve (AUC) for DNI in predicting SAP was 0.727, with a 95% Confidence Interval (CI) of 0.628-0.825. At the optimal cut-off point, the sensitivity of DNI was determined to be 74.3%, with a 95% CI of 56.7%-87.5%. The specificity was calculated as 68.2% (95% CI=61.6%-74.3%). The positive likelihood ratio (LR+) was 2.34, with a 95% CI of 1.78-3.08, and the negative likelihood ratio (LR-) was 0.38, with a 95% CI of 0.21-0.67. Conclusion: Based on the results, the delta neutrophil index (DNI) shows promise as an essential inflammatory marker for the early diagnosis of SAP. While it may not demonstrate high performance as a standalone marker, our study indicates that DNI could serve as an independent predictor for this outcome. The significant difference observed in DNI values between patients who developed SAP and non-severe patients suggests its potential clinical significance in identifying severe acute pancreatitis cases at an early stage. Further investigations and validation studies are warranted to strengthen the reliability and generalizability of DNI as a diagnostic tool for SAP. Integrating DNI with other relevant clinical and laboratory parameters may enhance its diagnostic accuracy and contribute to more effective patient management strategies. With appropriate intervention and follow-up, the early identification of SAP using DNI may lead to improved patient outcomes and reduced complications, benefiting both the patients and the healthcare system.

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients. This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded. There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05). This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.

Predictive value of immature granulocyte and delta neutrophil index in the diagnosis of complicated acute cholecystitis.

The complicated gallbladder disorders are associated with increased mortality and morbidity. Thus, this study was aimed at evaluating the predictive value of immature granulocyte count and delta neutrophil index in the prediction of complicated cholecystitis. We retrospectively reviewed patients who underwent surgery for acute cholecystitis between January 2018 and April 2022. Overall, 351 patients fulfilling the inclusion criteria were included in the study. In all patients, demographic data, immature granulocyte count (IGC), delta neutrophil index (DNI), white blood cell (WBC) count, C-reactive protein (CRP), and albumin levels were recorded. Based on operative findings and histopathological examination, the patients were classified into 2 groups uncomplicated (group I) and complicated (e.g., perforation, gangrenous and emphysematous cholecystitis; group II) groups. The IBM SPSS version 26.0 (SPSS Corp, Armonk, NY, USA) was used to assess differences in blood parameters between groups. The predictive values of the parameters evaluated were estimated using ROC analysis. A p-value<0.05 was considered statistically significant. Acute complicated cholecystitis was found in 138 of 351 patients. No significant difference was detected in age and gender distribution between groups (p=0.352 and p=0.214, respectively). When blood parameters were assessed, it was found that IGC, DNI, WBC, and CAR values were significantly higher in group II (p<0.001; p<0.001, p<0.001, and p=0.036, respectively), while there was no significant difference in CRP and albumin between groups (p=0.099 and p=0.53, respectively). In the ROC analysis, the highest AUC value was found for IG count and DNI (0.784 and 0.775, respectively). The sensitivity and specificity were found as 68.8% and 86.9% for IG count and 49.3% and 96.2% for DNI, respectively. The IG count and DNI are two novel parameters with strong predictive value in the early diagnosis of acute complicated cholecystitis, which may support clinical findings, imaging studies, and other laboratory parameters.

Usefulness of the delta neutrophil index in predicting surgery in patients with foot and ankle infection.

BackgroundIn foot and ankle infections, cases with apparent soft-tissue necrosis or purulent fluid collections definitely require surgical treatments. However, clinicians often have difficulty in determining whether to perform surgery in ambiguous cases without these findings. This study aimed to investigate the impact of the delta neutrophil index as a predictor of surgical treatment in patients with foot and ankle infections.MethodsIn total, 66 patients diagnosed with foot and ankle infections who underwent the delta neutrophil index test were retrospectively investigated. Medical records, including data on diabetes mellitus status, delta neutrophil index values, white blood cell count, polymorphonuclear leukocyte count, erythrocyte sedimentation rate, and C-reactive protein level, were retrospectively investigated. Logistic regression models were analyzed for the correlation between biomarkers, such as the delta neutrophil index and surgical treatment. The area under the curve was investigated to evaluate the cut-off value of the logistic model in predicting surgery.ResultsThe relationship between the delta neutrophil index and surgical treatment was analyzed. The delta neutrophil index, adjusted for diabetes mellitus, was the best predictor of future surgical intervention. Based on the Youden index, the cutoff point (the equation’s adjusted by diabetes mellitus) for the prediction of surgical treatment was defined as a probability of 0.3, with sensitivity and specificity of 82.4% and 77.6%, respectively.ConclusionsBased on the present study, the delta neutrophil index can help clinicians decide the appropriate surgical treatment for foot and ankle infections at the right time.

Delta neutrophil index as a predictor of vesicoureteral reflux in children with febrile urinary tract infection

Purpose: Delta neutrophil index (DNI) indicates immature granulocytes in peripheral blood and has been confirmed to be effective as a prognostic factor for neonatal sepsis. Also, it has been reported to have diagnostic value in acute pyelonephritis and in predicting vesicoureteral reflux (VUR) in the infant. We conducted the study to verify whether DNI is also helpful in the entire pediatric age group with febrile urinary tract infection (UTI).Methods: Medical records of children hospitalized for febrile UTIs were analyzed retrospectively. All subjects underwent kidney ultrasound and voiding cystourethrography. In the group with and without VUR, we compared sex and age, and the following laboratory values: the white blood cell count, neutrophil, polymorphonuclear leucocyte, eosinophil, hemoglobin, platelet count, C-reactive protein, DNI value, and the finding of ultrasound. Results: A total of 315 patients (163 males and 152 females; range, 0–127 months) were eligible, and 41 patients (13%) had VUR. As a result of univariate analysis, the white blood cell count, neutrophil, DNI, and ultrasonic abnormalities were high in the reflux group, and the hemoglobin and lymphocyte fraction values were low. The value of DNI and the abnormal ultrasound were significantly higher in the reflux group on the multivariate analysis. The area under the curve value of the receiver operating curve was higher in DNI (0.640; 95% confidence interval, 0.536–0.744; P=0.004), and the DNI cutoff value for VUR prediction was 1.85%.Conclusions: We identified that ultrasound findings and DNI values were helpful predictors of VUR in pediatric febrile UTIs.

Delta neutrophil index and shock index can stratify risk for the requirement for massive transfusion in patients with primary postpartum hemorrhage in the emergency department.

Postpartum hemorrhage (PPH) constitutes a major risk for maternal mortality and morbidity. Unfortunately, the severity of PPH can be underestimated because it is difficult to accurately measure blood loss by visual estimation. The delta neutrophil index (DNI), which reflects circulating immature granulocytes, is automatically calculated in hematological analyzers. We evaluated the significance of the DNI in predicting hemorrhage severity based on the requirement for massive transfusion (MT) in patients with PPH. We retrospectively analyzed data from a prospective registry to evaluate the association between the DNI and MT. Moreover, we assessed the predictive ability of the combination of DNI and shock index (SI) for the requirement for MT. MT was defined as a transfusion of ≥10 units of red blood cells within 24 h of PPH. In total, 278 patients were enrolled in this study and 60 required MT. Multivariable logistic regression revealed that the DNI and SI were independent predictors of MT. The optimal cut-off values of ≥3.3% and ≥1.0 for the DNI and SI, respectively, were significantly associated with an increased risk of MT (DNI: positive likelihood ratio [PLR] 3.54, 95% confidence interval [CI] 2.5-5.1 and negative likelihood ratio [NLR] 0.48, 95% CI 0.4-0.7; SI: PLR 3.21, 95% CI 2.4-4.2 and NLR 0.31, 95% CI 0.19-0.49). The optimal cut-off point for predicted probability was calculated for combining the DNI value and SI value with the equation derived from logistic regression analysis. Compared with DNI or SI alone, the combination of DNI and SI significantly improved the specificity, accuracy, and positive likelihood ratio of the MT risk. The DNI and SI can be routinely and easily measured in the ED without additional costs or time and can therefore, be considered suitable parameters for the early risk stratification of patients with primary PPH.

Increased serum delta neutrophil index levels are associated with intrahepatic cholestasis of pregnancy.

This study aims to compare the maternal serum delta neutrophil index (DNI) levels in intrahepatic cholestasis of pregnancy (ICP) and healthy pregnancies. This study consisted of a group of patients (n=40) diagnosed with isolated ICP who gave birth in our hospital and a control group (n=60) between December 1, 2015, and June 30, 2018. The diagnosis of ICP was made based on pruritus and elevated fasting serum bile acids and liver enzymes. Laboratory tests of both groups in the hospitalization process were retrospectively examined. Maternal and neonatal characteristics, pregnancy outcomes, and DNI values of the two groups were compared. Statistical analyses were performed using SPSS version 20. Mean maternal serum DNI levels were significantly higher in women with ICP than in the control group (0.49 ± 4.8 vs -3.99 ± 3.02, p=<0.01). Receiver operating characteristic (ROC) curve analysis was used to define the DNI value where ICP can be best predicted. DNI, a new inflammatory marker, was found to be higher in women with ICP than in normal pregnancies.

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

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.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders.

We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa. The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements). Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women?

IntroductionAcute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. Patients and methodsHerein, 1542 patients, aged 18–49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. ResultsIn the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). ConclusionThe Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women.

Delta neutrophil index and symptomatic time are effective factors for predicting perforated appendicitis.

Appendicitis is a common intra-abdominal inflammatory disease, and morbidity increases with age when perforation occurs. Because, not all patients require emergency surgery, there have been numerous studies on factors for predicting perforated appendicitis. In this study, we aimed to confirm whether the delta neutrophil index (DNI) and the time from symptom onset to surgery are effective predictors for perforated appendicitis in different age groups.This was a retrospective study conducted on 542 appendicitis patients who underwent surgery at Kangdong Sacred Heart Hospital. The simple group consisted of 431 subjects, and the perforation group consisted of 111 subjects.Multiple logistic regression analyses demonstrated that age, neutrophil percentage, DNI, C-reactive protein (CRP), and symptomatic time were significant predictors of perforation. Analysis of the receiver-operating characteristic curve showed that the DNI was the most reliable predictive value. In the analyses according to age, the perforation rate was higher in the >65-year-age group; these patients also had a higher DNI, CRP, and symptomatic time. In the DNI analysis using receiver operating characteristic (ROC) analysis, the area under the curve was higher in the >65-year-age group than in other age groups. In addition, the cutoff values have been determined and perforation occurred significantly in the group with a DNI value of 2.1 or higher and a symptomatic time of 33 hours or longer.DNI is effective in predicting perforation in patients with appendicitis compared with other inflammatory factors. Furthermore, the simultaneous measurement of symptomatic time and DNI is helpful in predicting perforation and determining whether emergency surgery is necessary.

Association between Novel Marker (Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio, and Delta Neutrophil Index) and Outcomes in Sudden Cardiac Arrest Patients.

Purpose It is important that clinicians accurately predict the outcome of patients with sudden cardiac arrest (SCA). The complete blood count (CBC) is an easy and inexpensive test that provides information on blood content. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and delta neutrophil index (DNI) are relatively novel biomarkers that have been used in the prognosis of various diseases. We aimed to determine the usefulness of PLR, NLR, and DNI in predicting the outcomes of SCA. Materials and Methods This retrospective observational study was performed on patients with SCA. Patients who visited the tertiary university hospital from January 2015 to December 2019 were targeted. The inclusion criteria were all nontraumatic adult out-hospital cardiac arrest patients. We analyzed DNI, PLR, and NLR based on the CBC results of all enrolled patients. The exclusion criteria were as follows: no data on laboratory study, traumatic arrest, age < 18 years, and a history of leukemia, myelodysplastic syndrome, and myelofibrosis. The primary outcome was assessed as return of spontaneous circulation (ROSC), the secondary outcome as survival to discharge, and the tertiary outcome as neurological outcome. Results From January 1, 2015, to December 31, 2019, 739 patients were enrolled. ROSC was seen in 324 patients, of whom 60 had survival to discharge and 24 had good neurological outcome at the time of discharge (cerebral performance categories (CPCs) 1-2). The PLR of the ROSC group was 42.41 (range: 4.21–508.7), which was higher than that of the No-ROSC group (p=0.006). The DNI value of the survival group was 0.00 (range: 0.00–40.9), which was lower than that of the nonsurvival group. Conclusions Patients with SCA and subsequent ROSC had higher PLR and NLR, while those with survival to discharge had lower DNI values than those with nonsurvival to discharge (p=0.005).

Delta Neutrophil Index as a Diagnostic Marker of Neonatal Sepsis

Abstract Objective Sepsis diagnosis is challenging due to nonspecific symptomatology in newborns. Timely diagnosis is essential for reducing sepsis-related morbidity and mortality. This study was performed to determine the diagnostic value of the delta neutrophil index (DNI) for detection of neonatal sepsis and to compare its efficacy with other conventional markers. Methods This study was conducted at a tertiary hospital in newborns with confirmed sepsis (n = 59), suspected sepsis (n = 46), and in age- and weight-matched controls (n = 49). DNI, white blood cell count, C-reactive protein (CRP) level, and platelet measurements were determined, and blood cultures were performed at the onset of symptoms. Results The mean DNI was significantly higher in confirmed and clinical sepsis groups compared with the control group. (6.9 ± 9.3, 1.9 ± 2.1, and 0.4 ± 0.5, respectively, p &lt; 0.001). ROC curve analysis also showed that the combination of DNI and CRP had the highest sensitivity (86%), specificity (100%), and positive predictive value (100%) for predicting neonatal sepsis. DNI values were significantly higher in nonsurvivors (p &lt; 0.05). Conclusion DNI could be used as a reliable diagnostic marker for neonatal sepsis, and high DNI could predict sepsis development and unfavorable outcomes. The diagnostic capability of DNI may be increased by assessing CRP measurements simultaneously.

The role of the delta neutrophil index in determining the etiology of neonatal sepsis

Abstract Objectives To demonstrate immature granulocyte (IG) count and delta neutrophil index (DNI) values (novel potential predictive marker for neonatal sepsis) for neonates. Methods This prospective controlled clinical study was consisted of 208 patients (77 in the study group and 131 in the control group) who were delivered between January 2016 and January 2018 at the Hacettepe University Neonatal Intensive Care Unit in Ankara, Turkey. In this study, we evaluated value of DNI in diagnosing neonatal sepsis by comparing the DNI values in culture positive septic neonates with healthy neonates. Results In our study, the median interquartile range (IQR = 25–75%) DNI was 0.1% (0.0–0.3%) in the control group and 1.5% (1.0–2.45%) in the sepsis group (p &lt; 0.05). In our ROC curve analysis, the cut-off value for the DNI as a sepsis marker was 0.65%, with 96.2% specificity and 97.4% sensitivity. Those patients with gram-negative isolates had significantly higher DNI and IG counts when compared to those patients with gram-positive bacteria (p &lt; 0.05). Conclusions Our findings indicated that the DNI counts are significant diagnostic biomarkers for neonatal sepsis. They may also have utility in determining the sepsis etiology (differentiating between gram-positive and gram-negative agents).

Delta neutrophil index as a predictive and prognostic factor for Candidemia patients: a matched case-control study

BackgroundDelayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients.MethodsA matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia.ResultsThe 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p < 0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421–3.217, p < 0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719–0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group.ConclusionsDNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.

Is the serum delta neutrophil index level different in gestational diabetic women?

Objective: To investigate the serum delta neutrophil index (DNI) levels between normal pregnant women and gestational diabetic women.Methods: Normal pregnant women and gestational diabetic women delivered in the University of Health Sciences Etlik Zübeyde Hanım Women’s Health Care, Training and Research Hospital between 1 December 2015 and 30 June 2018 were included in the study. The study group included patients diagnosed with gestational diabetes by a 100-g or 75-g OGTT (n = 273). The control group included women with singleton pregnancies who had normal antenatal follow-up and who had delivered healthy neonates after 37 gestational weeks (n = 455). In both the study and control groups, for the analysis of DNI and other laboratory values, the ones reported at the time of the application for delivery or within previous 4 weeks of delivery were used. The study and control groups were compared with each other with respect to the DNI value (primary outcome measure of the study), maternal and newborn characteristics, pregnancy outcomes and laboratory values other than DNI (secondary outcome measures). Statistical analyses were performed using SPSS for Windows, version 22.0. The Student t-test, the Mann–Whitney U-test, and the χ2 test were used where appropriate. A p value of <.05 was considered statistically significant.Results: There were significant differences between the study and control groups regarding median maternal age, gravidity, parity, BMI and gestational age at delivery (p < .05). Mean birthweight was significantly higher in the study group compared to control group (p=.002). NICU admission was significantly more frequent in the study group than in the control group (8.8% vs 2.4%; p < .001). The platelet, WBC, neutrophil and monocyte counts and NLRs were significantly lower, while Hb and DNI values were significantly higher in the study group than in the control group. The median DNI values were –2.30 (range: −27.0 to 8.10) and –3.0(range: −27.30 to 11.60) in the study and control groups, respectively (p = .007).Conclusion: The DNI, a new inflammatory marker, was found to be higher in gestational diabetic women, than in those with normal pregnancies.

Prognostic value of the delta neutrophil index in pediatric cardiac arrest

The delta neutrophil index (DNI), which reflects the ratio of circulating immature neutrophils, has been reported to be highly predictive of mortality in systemic inflammation. We investigated the prognostic significance of DNI value for early mortality and neurologic outcomes after pediatric cardiac arrest (CA). We retrospectively analyzed the data of eligible patients (<19 years in age). Among 85 patients, 55 subjects (64.7%) survived and 36 (42.4%) showed good outcomes at 30 days after CA. Cox regression analysis revealed that the DNI values immediately after the return of spontaneous circulation, at 24 hours and 48 hours after CA, were related to an increased risk for death within 30 days after CA (P < 0.001). A DNI value of higher than 3.3% at 24 hours could significantly predict both 30-day mortality (hazard ratio: 11.8; P < 0.001) and neurologic outcomes (odds ratio: 8.04; P = 0.003). The C statistic for multivariable prediction models for 30-day mortality (incorporating DNI at 24 hours, compression time, and serum sodium level) was 0.799, and the area under the receiver operating characteristic curve of DNI at 24 hours for poor neurologic outcome was 0.871. Higher DNI was independently associated with 30-day mortality and poor neurologic outcomes after pediatric CA.