Korean J Crit Care Med.  2016 Nov;31(4):351-358. 10.4266/kjccm.2016.00171.

Delta Neutrophil Index as a Prognostic Marker in the Pediatric Intensive Care Unit

• Sol IS
• Park HB
• Kim MJ
• Yoon SH
• Kim YH
• Kim KW
• Sohn MH
• Kim KE

• KMID: 2371191
• DOI: http://doi.org/10.4266/kjccm.2016.00171

Abstract

BACKGROUND
The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors.
METHODS
A total of 516 children admitted to Severance Children's Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission.
RESULTS
The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%.
CONCLUSIONS
The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.

Keyword

child; intensive care unit; mortality; prognostic factor

MeSH Terms

C-Reactive Protein
Child
Critical Care*
Humans
Intensive Care Units*
Lactic Acid
Mortality
Neutrophils*
Prognosis
ROC Curve
Sepsis
Survivors
C-Reactive Protein
Lactic Acid

Figure

• 

  Fig. 1. Receiver operating characteristic curve of delta neutrophil index for survival prediction (area under the curve: 0.748; 95% confidence interval: 0.687-0.808).

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  Fig. 2. Survival curves for patients with delta neutrophil index (DNI) < 5.0% (solid line) and DNI ≥ 5.0% (dotted line). DN: delta neutrophil; PICU: pediatric intensive care unit.

Reference

References

1. Hwang HS, Lee NY, Han SB, Kwak GY, Lee SY, Chung SY, et al. Performance effectiveness of pediatric index of mortality 2 (PIM2) and pediatricrisk of mortality III (PRISM III) in pediatric patients with intensive care in single institution: Retrospective study. Korean J Pediatr. 2008; 51:1158–64.

2. Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet. 2003; 362:192–7.

3. Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr. 2010; 77:267–71.

4. Sankar J, Chandel A, Dubey NK, Sreenivas V, Sankar MJ. Do interventions in an ICU affect the predictive ability of pediatric index of mortality and pediatric index of mortality-2 scores in a tertiary care hospital? Pediatr Crit Care Med. 2013; 14:e70–6.

5. Wolfler A, Osello R, Gualino J, Calderini E, Vigna G, Santuz P, et al. The importance of mortality risk assessment: Validation of the pediatric index of mortality 3 score. Pediatr Crit Care Med. 2016; 17:251–6.

6. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003; 123:2043–9.

7. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000; 28:1871–6.

8. Kim YH, Park HB, Kim MJ, Kim HS, Lee HS, Han YK, et al. Usefulness of thrombocytopenia and changes in platelet counts as prognostic markers in pediatric intensive care units. Korean J Crit Care Med. 2013; 28:93–100.

9. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006; 34:2596–602.

10. Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH. Transthyretin as a marker to predict outcome in critically ill patients. Clin Biochem. 2008; 41:1126–30.

11. Abidi K, Belayachi J, Derras Y, Khayari ME, Dendane T, Madani N, et al. Eosinopenia, an early marker of increased mortality in critically ill medical patients. Intensive Care Med. 2011; 37:1136–42.

12. Nahm CH, Choi JW, Lee J. Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis. Ann Clin Lab Sci. 2008; 38:241–6.

13. Harris N, Kunicka J, Kratz A. The ADVIA 2120 hematology system: flow cytometry-based analysis of blood and body fluids in the routine hematology laboratory. Lab Hematol. 2005; 11:47–61.

14. Kratz A, Maloum K, O’Malley C, Zini G, Rocco V, Zelmanovic D, et al. Enumeration of nucleated red blood cells with the ADVIA 2120 Hematology System: an International Multicenter Clinical Trial. Lab Hematol. 2006; 12:63–70.

15. Park BH, Kang YA, Park MS, Jung WJ, Lee SH, Lee SK, et al. Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis. BMC Infect Dis. 2011; 11:299.

16. Park HJ, Ha YJ, Pyo JY, Park YB, Lee SK, Lee SW. Delta neutrophil index as an early marker for differential diagnosis of adult-onset Still’s disease and sepsis. Yonsei Med J. 2014; 55:753–9.

17. Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2003; 120:795–9.

18. Bernstein LH, Rucinski J. Measurement of granulocyte maturation may improve the early diagnosis of the septic state. Clin Chem Lab Med. 2011; 49:2089–95.

19. Nigro KG, O’Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005; 123:618–24.

20. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996; 24:743–52.

21. Slater A, Shann F, Pearson G. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med. 2003; 29:278–85.

22. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med. 2013; 14:673–81.

23. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143:29–36.

24. Youden WJ. Index for rating diagnostic tests. Cancer. 1950; 3:32–5.