Delta neutrophil index levels can be a good indicator to predict patients with chronic rhinosinusitis who need surgery

Objectives Predicting the need for surgical treatment among patients with chronic rhinosinusitis (CRS) is challenging. The delta neutrophil index (DNI) has been proposed as a useful laboratory marker of immature granulocytes, which indicates infection or severe inflammation in several diseases. This study evaluated DNI as an early predictor of the need for surgery in patients with CRS. Methods A total of 117 patients diagnosed with CRS were enrolled in this retrospective and observational study. Medical records, including symptoms data, WBC count, ESR level, LUC count, Lund-Mackay scores, and DNI, were reviewed. The receiver operating characteristic (ROC) curves were analyzed to determine the optimal cut-off values for predicting surgery. Results Among 117 patients, 49 patients (41.9%) needed surgical intervention. The areas under the WBC, ESR, LUC, and DNI ROC curves were .571, .600, .592, and .782, respectively. The optimal cut-off value of DNI to predict surgery was .9%. The prognostic precision of DNI showed that the sensitivity was 59.2% and the specificity was 98.5%. In the analysis of risk factors, DNI levels were significantly associated with surgical intervention (odds ratio, 2.22; 95% confidence interval, 1.48-3.34; P < .01). Conclusions The level of DNI, which reflects the severity of the disease, may be a useful predictor for determining the need for surgical intervention in patients with CRS. This is the first literature to verify the role of DNI in upper airway disease.

Delta neutrophil index: in search of an early indicator of sepsis

Introduction: Sepsis is a significant cause of morbidity and mortality worldwide. Current clinical practice, however, lacks reliable diagnostic indicators for it and its prognosis. Aim: The present study aimed to investigate the efficacy of delta neutrophil index (DNI), which reflects the proportion of circulating immature granulocytes, in predicting infections and sepsis. Materials and methods: A prospective non-interventional single-center clinical follow-up study was performed in a Bulgarian ICU&nbsp; between January 1, 2017 and May 31, 2018.&nbsp; We analyzed adult patients: 45 patients met the sepsis criteria, as defined in SEPSIS-3, whereas 37 were infected patients fulfilling no criteria of sepsis. Logistic regression and Roc-curve analysis were used to evaluate the severity and prognostic value of DNI as a prediction marker in critically ill septic patients. Results: The results have shown that at DNI values of 1.4 there is 73% sensitivity and 87% specificity (AUC 0.764, 95% CI 0.650&ndash;0.878, p=0.0001) to assume the presence of sepsis. Additionally, DNI was significantly associated with the severity of the condition of patients, the organ dysfunction and the IL-8 marker. Conclusions: DNI may serve as a useful marker for early diagnosis of sepsis and could support decision making process regarding its treatment at an early stage of a disease development.

Delta Neutrophil Index: A Potential Diagnostic Marker of Multisystem Inflammatory Syndrome in Children (MIS-C)

Background Multisystem inflammatory syndrome in children (MIS-C) is a life threatening hiperinflamation syndrome emerging after COVID-19. The serum delta neutrophil index (DNI), reflects the fraction of circulating immature granulocytes and elevated in infection and inflammation. The aim of this study is to evaluate the usefulness of DNI as a diagnostic marker in patients with MIS-C and to assess its role in determining the severity of MIS-C. Methods This retrospective, observational study included 83 patients of MIS-C and 113 patients of COVID-19 and control group. C-reactive protein, absolute neutrophil count, absolute lymphocyte count, DNI and platelet count were recorded. Results The DNI levels were 4.60 ± 5.70% in the MIS C group and 0.30 ± 0.99% in the COVID group and 0.20 ± 0.56% in the control group (p < 0.001). According to the severity of MIS-C, the DNI level was found 1,22% in mild MIS-C, 4,3% in moderate MIS-C and 5,7% in severe MIS-C. There was a statistically significant correlation between the DNI levels and the severity of MIS-C. The cutoff value of DNI for predicting MIS-C was 0.45%. In the correlation analysis of DNI with CRP, ANC, ALC and platelet count, sensitivity, specificity, positive predictive value and negative predictive value were found to be 79.5%, 97.1%, 95.7%, and 85.3%, respectively. Conclusions DNI was identified as a predictive factor for diagnosis of MIS-C such as ANC, ALC, platelet count and CRP. DNI levels in hemogram analysis may guide clinicians in determining the diagnosis and severity of MIS-C.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders

Objective We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa. Methods The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements). Results Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814–0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770–0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) Conclusion Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.