title: Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  One 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.
  
  
  RESULTS
  Forty 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.
  
  
  CONCLUSIONS
  DNI 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.
authors: Department of Internal Medicine, Severance Hospital, Seoul, Korea.
authors: Byung Hoon
authors: BH
authors: Park
authors: Young Ae
authors: YA
authors: Kang
authors: Moo Suk
authors: MS
authors: Park
authors: Won Jai
authors: WJ
authors: Jung
authors: Su Hwan
authors: SH
authors: Lee
authors: Sang Kook
authors: SK
authors: Lee
authors: Song Yee
authors: SY
authors: Kim
authors: Se Kyu
authors: SK
authors: Kim
authors: Joon
authors: J
authors: Chang
authors: Ji Ye
authors: JY
authors: Jung
authors: Young Sam
authors: YS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000473:pathology*; D012720:Severity of Illness Index