title: Usefulness of the Delta Neutrophil Index to Predict 30-Day Mortality in Patients with Upper Gastrointestinal Bleeding.
abstract: The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with systemic inflammation. It is rapidly and easily measured while performing a complete blood count. This study aimed to determine whether the DNI can predict short-term mortality in patients presenting to the emergency department (ED) with upper gastrointestinal hemorrhage (UGIH).
  
  
  
  We retrospectively identified consecutive patients (>18 years old) with UGIH admitted to the ED from January 1, 2015 to February 28, 2016. The diagnosis of UGIH was confirmed using clinical, laboratory, and endoscopic findings. The DNI was determined on each day of hospitalization. The outcome of interest was 30-day mortality.
  
  
  
  Overall, 432 patients with UGIH met our inclusion criteria. The multivariate Cox regression model demonstrated that higher DNI values on days 0 (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02-1.17; P = 0.012) and 1 (HR, 1.15; 95% CI, 1.06-1.24; P = 0.001) were strong independent predictors of short-term mortality. Further, a DNI >1% at ED admission was associated with an increased risk (HR, 40.9; 95% CI, 20.8-80.5; P < 0.001) of 30-day mortality. The optimal cut-off value for DNI on day 1 was 2.6%; this was associated with an increased hazard of 30-day mortality following UGIH (HR, 7.85; 95% CI, 3.59-17.15; P < 0.001).
  
  
  
  The DNI can be measured rapidly and simply at ED admission without additional cost or time burden. Increased DNI values independently predict 30-day mortality in patients with UGIH.
authors.affiliation: *Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea†Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, 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, Republic of Korea.
authors.forename: Taeyoung
authors.initials: T
authors.lastname: Kong
authors.forename: Sangkook
authors.initials: S
authors.lastname: In
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Je Sung
authors.initials: JS
authors.lastname: You
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Chung
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
mesh_terms: D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009504:Neutrophils; D012189:Retrospective Studies; D013997:Time Factors