title: Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments.
abstract: Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analyzers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis.
  
  
  
  We retrospectively analyzed patients initially diagnosed with acute cholangitis at emergency department admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality.
  
  
  
  We included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053-1.153; P < 0.001), day 1 (HR: 1.069; 95% CI: 1.018-1.122; P = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053-1.186; P < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI > 4.9% at admission (HR: 5.632; 95% CI: 1.977-16.045; P = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666-37.302; P < 0.001) and higher DNI ( > 2.5%) on day 2 (HR, 16.942; 95% CI: 2.15-133.496; P = 0.007) were associated with increased 28-day mortality.
  
  
  
  Higher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.
authors: *Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea †Department of Health Insurance Research, National Health Insurance Service Ilsan Hospital, Gayang, Republic of Korea ‡Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Republic of Korea §Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyunchul
authors: H
authors: Kim
authors: Taeyoung
authors: T
authors: Kong
authors: Sung Phil
authors: SP
authors: Chung
authors: Jung Hwa
authors: JH
authors: Hong
authors: Jong Wook
authors: JW
authors: Lee
authors: Youngseon
authors: Y
authors: Joo
authors: Dong Ryul
authors: DR
authors: Ko
authors: Je Sung
authors: JS
authors: You
authors: Incheol
authors: I
authors: Park
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002761:Cholangitis / Q000097:blood* / Q000473:pathology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers