title: Newly designed delta neutrophil index-to-serum albumin ratio prognosis of early mortality in severe sepsis.
abstract: OBJECTIVE
  We evaluated the ratio of delta neutrophil index (DNI) to albumin (A) in patients receiving early goal-directed therapy (EGDT) to determine the prognostic significance of the DNI/A ratio as a marker of early mortality in critically ill patients with suspected sepsis.
  
  
  METHODS
  We retrospectively analyzed records from a prospective EGDT registry in an emergency department (ED) and screened eligible adult patients who were admitted to the ED with severe sepsis and/or septic shock. The new DNI/A ratio was calculated as the DNI value on each hospital day divided by the initial albumin level on ED admission. The clinical outcome was mortality after 28 days.
  
  
  RESULTS
  A total of 120 patients receiving EGDT were included in this study. Multivariate Cox proportional-hazard models revealed that higher DNI/A ratios on day 1 (hazard ratio [HR], 1.068; 95% confidence interval [CI], 1.01-1.13; P = .0209) and the peak day (HR, 1.057; 95% CI, 1.001-1.116; P = .0456) were independent risk factors for mortality at 28 days. Our study demonstrated that the increased trend toward 28-day mortality was associated with a DNI/A ratio greater than 8.4 on day 1 (HR, 2.513; 95% CI, 0.950-6.64; P = .0528) and a higher DNI/A ratio (>6.4) on the peak day (average, 4.2 days; HR, 2.953; 95% CI, 1.033-8.441; P < .001) in patients with severe sepsis receiving EGDT.
  
  
  CONCLUSIONS
  The ratio of DNI to serum albumin on ED admission is a promising prognostic marker of 28-day mortality in patients with severe sepsis receiving EGDT.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea.
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Republic of Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea. Electronic address: youjsmd@yuhs.ac.
authors.forename: Je Sung
authors.initials: JS
authors.lastname: You
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000401:mortality* / Q000628:therapy; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin