Yonsei Med J.  2018 May;59(3):397-405. 10.3349/ymj.2018.59.3.397.

Delta Neutrophil Index Is Associated with Vasculitis Activity and Risk of Relapse in ANCA-Associated Vasculitis

• Yoo J
• Ahn SS
• Jung SM
• Song JJ
• Park YB
• Lee SW

• KMID: 2407863
• DOI: http://doi.org/10.3349/ymj.2018.59.3.397

Abstract

PURPOSE
Delta neutrophil index (DNI) represents the immature granulocytes count associated with neutrophil-consumption. We investigated whether DNI might be associated with Birmingham vasculitis activity score (BVAS) at diagnosis and could predict relapse during the follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
MATERIALS AND METHODS
We reviewed the medical records of 97 patients having DNI results. Twenty patients had granulomatosis with polyangiitis (GPA), 58 had microscopic polyangiitis (MPA), and 19 had eosinophilic GPA (EGPA). We collected clinical and laboratory data including BVAS, five factor score (FFS), and DNI. The correlation coefficient and cumulative relapse free survival rate were obtained. The optimal cut-off of DNI was extrapolated by calculating the area under the receiver operator characteristic curve.
RESULTS
DNI was significantly related to cross-sectional BVAS. Furthermore, among continuous variables, only DNI could reflect BVAS of GPA and MPA, but not EGPA. Severe AAV was defined as BVAS ≥20 (the highest quartile). At diagnosis, patients having DNI ≥0.65% had a significantly higher risk of severe GPA and MPA than those having not (relative risk 4.255) at diagnosis. During the follow-up, DNI ≥0.65% could predict the higher relapse rate.
CONCLUSION
DNI could reflect BVAS at diagnosis and furthermore, DNI ≥0.65% could not only identify severe AAV at diagnosis, but also predict relapse during the follow-up in patients with GPA and MPA.

Keyword

Delta neutrophil index; granulomatosis with polyangiitis; microscopic polyangiitis; vasculitis activity

MeSH Terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Cytoplasm
Diagnosis
Eosinophils
Follow-Up Studies
Granulocytes
Granulomatosis with Polyangiitis
Humans
Medical Records
Microscopic Polyangiitis
Neutrophils*
Recurrence*
Survival Rate
Vasculitis*

Figure

• 

  Fig. 1 DNI identified severe AAV at diagnosis and predicted relapse of GPA and MPA during the follow-up. (A) Patients having DNI ≥0.65% had severe AAV (BVAS ≥20) more frequently than those having DNI <0.65% (35.3% vs. 11.4%, p=0.011). (B) In Kaplan-Meier survival analysis, patients having DNI ≥0.65% exhibited lower cumulative relapse free survival rate than those having DNI <0.65% (p=0.029). DNI, delta neutrophil index; AAV, antineutrophil cytoplasmic antibody-associated vasculitis; GPA, granulomatosis with polyangiitis; MPA, microscopic polyangiitis; BVAS, Birmingham vasculitis activity score; RR, relative risk.

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