title: D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections.
abstract: OBJECTIVE
  Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia.
  
  
  METHODS
  Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative-D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI.
  
  
  RESULTS
  The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000-22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%.
  
  
  CONCLUSIONS
  The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.
authors.affiliation: Ankara University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ankara, Turkey, Phone : +90 312 508 27 15, E-mail : drguldeny@yahoo.com.tr.
authors.forename: Gülden
authors.initials: G
authors.lastname: Yılmaz
authors.forename: Belgin
authors.initials: B
authors.lastname: Coşkun
authors.forename: Atilla
authors.initials: A
authors.lastname: Elhan
authors.forename: Alpay
authors.initials: A
authors.lastname: Azap
authors.forename: Hamdi
authors.initials: H
authors.lastname: Akan
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D064147:Febrile Neutropenia / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D000072742:Invasive Fungal Infections / Q000175:diagnosis* / Q000209:etiology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D013997:Time Factors