Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsisReport as inadecuate

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BMC Infectious Diseases

, 11:299

Bacterial and fungal diseases


BackgroundThe immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions delta neutrophil index, DNI in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis.

MethodsOne hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels was determined using a specific blood cell analyzer.

ResultsForty four patients 42.7% were diagnosed with severe sepsis-septic shock. Overt disseminated intravascular coagulation DIC occurred in 40 38.8%. DNI was significantly higher in patients with severe sepsis-septic shock and overt DIC than in patients without p < 0.05. DNI correlated with DIC score r = 0.54, p < 0.001. We observed a monotonic increase in the proportion of overt DIC and severe sepsis-septic shock associated with increasing quartiles of DNI p < 0.001. A DNI value > 6.5% was a better indicator of severe sepsis-septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%. In 36 82% of the 44 patients with severe sepsis-septic shock, DNI values were already elevated up to 12 hours before the onset of organ-circulatory failure.

ConclusionsDNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis-septic shock.

List of abbreviationsDNIdelta neutrophil index

DICdisseminated intravascular coagulation

ICUintensive care unit


SIRSsystemic inflammatory response syndrome

SAPSSimplified Acute Physiology Score

SOFASequential Organ Failure Assessment

WBCwhite blood cell

RBCred blood cell

PTprothrombin time

aPTTactivated partial thromboplastin time

CRPC-reactive protein

ROCReceiver-operating characteristics

AUCareas under the curves.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-11-299 contains supplementary material, which is available to authorized users.

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Author: Byung Hoon Park - Young Ae Kang - Moo Suk Park - Won Jai Jung - Su Hwan Lee - Sang Kook Lee - Song Yee Kim - Se Kyu


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