title: Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non-perforated appendicitis in the elderly.
abstract: BACKGROUND
  Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis.
  
  
  METHODS
  This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24-month period.
  
  
  RESULTS
  Sixty-nine of the 108 patients (median, IQR: 72, 67-77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non-perforated appendicitis group (36.1%). WBC, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51-35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut-off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807).
  
  
  CONCLUSIONS
  Clinicians can reliably differentiate acute perforated appendicitis from non-perforated appendicitis by DNI level of 1.4 or more in elderly patients.
authors.affiliation: Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Cho
authors.affiliation: National Medical center, Seoul, Korea.
authors.forename: Yoon Sung
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.|Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea.
authors.forename: Young Taeck
authors.initials: YT
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, School of Medicine, Konkuk University Konkuk University Medical Center, Seoul, Korea.
authors.forename: Sang O
authors.initials: SO
authors.lastname: Park
authors.affiliation: Department of Neurobiology, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea.
authors.forename: Moo-Ho
authors.initials: MH
authors.lastname: Won
authors.affiliation: Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea.
authors.forename: Jun Hwi
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Molecular and Cellular Biochemistry, College of Medicine, Kangwon National University, Chunchon, Korea.
authors.forename: Young Myeong
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, School of Medcine, Hallym University, Chunchon, Korea.
authors.forename: Jeong Yeol
authors.initials: JY
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.|Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea.
authors.forename: Young Hwan
authors.identifier: http://orcid.org/0000-0002-7340-2946
authors.initials: YH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001064:Appendicitis / Q000097:blood* / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood*; D001772:Blood Cell Count; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009504:Neutrophils / Q000166:cytology*; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: appendicitis; delta neutrophil index; perforated appendicitis