Electrolyte Blood Press.  2019 Jun;17(1):7-15. 10.5049/EBP.2019.17.1.7.

Delta Neutrophil Index is Useful to Predict Poor Outcomes in Male Patients with Alcoholic Ketoacidosis

• Kim MK
• Shin HW
• Kim YJ
• Yang JW
• Kim JS
• Han BG
• Choi SO
• Lee JY

• KMID: 2451516
• DOI: http://doi.org/10.5049/EBP.2019.17.1.7

Abstract

BACKGROUND
Alcoholic ketoacidosis (AKA) is known as a benign disease, but the related mortality reported in Korea is high. Acidosis and alcohol change the immunity profile, and these changes can be identified early using the delta neutrophil index (DNI). We aimed to evaluate the use of DNI and other standard laboratory parameters as predictors of prognosis in AKA patients.
METHODS
One hundred eighteen males with AKA were evaluated at the Wonju Severance Christian hospital between 2009 and 2014. We performed a retrospective analysis of demographic, clinical, and laboratory parameters data. Receiver operating characteristic curves (ROC) and multivariate Cox regression was used to identify renal survival and mortality.
RESULTS
Survival patients had lower initial DNI levels than non-survival patients (4.8±6.4 vs 11.4±12.5, p<0.001). In multivariate-adjusted Cox regression analysis, higher initial increased DNI (HR 1.044, 95% CI 1.003-1.086, p=0.035), and lower initial pH (HR 0.044, 95% CI 0.004-0.452, p=0.008) were risk factors for dialysis during hospitalization. Further, higher initial DNI level (HR 1.037; 95% CI 1.006-1.069; p=0.018), lower initial pH (HR 0.049; 95% CI 0.008-0.312; p=0.001) and lower initial glomerular filtration rate (GFR) (HR 0.981; 95% CI 0.964-0.999; p=0.033) were predictors of mortality. A DNI value of 4.5% was selected as the cut-off value for poor prognosis and Kaplan-Meier plots showed that AKA patients with an initial level DNI ≥4.5% had lower cumulative survival rates than AKA patients with an initial DNI <4.5%.
CONCLUSION
Increased initial serum DNI levels may help to predict renal survival and prognosis in male AKA patients.

Keyword

Alcoholic ketoacidosis; Prognosis; Delta neutrophil index

MeSH Terms

Acidosis
Alcoholics*
Dialysis
Gangwon-do
Glomerular Filtration Rate
Hospitalization
Humans
Hydrogen-Ion Concentration
Ketosis*
Korea
Male*
Mortality
Neutrophils*
Prognosis
Retrospective Studies
Risk Factors
ROC Curve
Survival Rate

Figure

• 

  Fig. 1 Receiver operating characteristics (ROC) curves of DNI, pH, and CRP for differentiating between the presence and absence of renal replacement therapy during hospital days.

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  Fig. 2 Kaplan-Meier plots for cumulative renal survival during hospital days (according to DNI level).

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  Fig. 3 Receiver operating characteristics (ROC) curves of DNI, and pH for differentiating between survival and non-survival patients during hospital days.

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