J Korean Soc Emerg Med.  2017 Oct;28(5):403-412. 10.0000/jksem.2017.28.5.403.

Usefulness of Delta Neutrophil Index to Predict 30-day Mortality in Patients with Mechanical Bowel Obstruction

• Han S
• You JS
• Chung SP
• Lee HS
• Kong T
• Kim JH
• Ko D
• Joo Y
• Choa M
• Park I

• KMID: 2394388
• DOI: http://doi.org/10.0000/jksem.2017.28.5.403

Abstract

PURPOSE
Mechanical bowel obstruction (MBO) is a common emergency problem resulting in high morbidity and mortality. The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with infection and/or systemic inflammation. This study was conducted to investigate the relationship between DNI and 30-day mortality in patients with MBO.
METHODS
We retrospectively identified consecutive patients (>18 years old) with MBO admitted to the emergency department from January 1, 2013 to April 30, 2015. The diagnosis of MBO was confirmed using clinical and radiological findings. The DNI was determined on each day of hospitalization. The outcome of interest was the 30-day mortality and the prognostic value of DNI for 30-day mortality was ascertained by Cox proportional hazards model analysis.
RESULTS
A total of 518 patients with MBO were included in this study. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR], 1.080; 95% confidence interval [CI], 1.036-1.126; p<0.001) was a strong independent predictor of short-term mortality. Among patients with MBO, a DNI >1.9% on admission (HR, 9.410; 95% CI, 2.671-33.145; p<0.001) was associated with increased 30-day mortality. Furthermore, the accuracy of DNI for predicting 30-day mortality was superior to that of other parameters.
CONCLUSION
The DNI can be measured rapidly and simply on emergency department admission without additional cost or time burden. Increased DNI values are associated with 30-day mortality in patients with MBO.

Keyword

Delta neutrophil index; Mechanical bowel obstruction; Mortality

MeSH Terms

Diagnosis
Emergencies
Emergency Service, Hospital
Granulocytes
Hospitalization
Humans
Inflammation
Mortality*
Neutrophils*
Proportional Hazards Models
Retrospective Studies