5 years ago

The delta neutrophil index is a prognostic factor for postoperative mortality in patients with sepsis caused by peritonitis

Won Hyuk Choi, Jeong Yeon Kim, Jong Wan Kim, Doo Jin Kim, Jun Ho Park, Jin Cheol Cheong

by Jong Wan Kim, Jun Ho Park, Doo Jin Kim, Won Hyuk Choi, Jin Cheol Cheong, Jeong Yeon Kim


The delta neutrophil index (DNI) represents the fraction of circulating immature granulocytes and is a marker of infection and sepsis. Our objective was to evaluate the usefulness of DNI for predicting in-hospital mortality within 30 days after surgery in patients with sepsis caused by peritonitis by means of comparing DNI, white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP) before and after surgery.

Materials and methods

We performed a retrospective analysis of demographic, clinical, and laboratory data. DNI, WBC count, neutrophil percentage, and CRP were measured before surgery, and at 12–36 h (day 1) and 60–84 h (day 3) after surgery.


There were 116 (73.7%) survivors and 44 (26.3%) non-survivors. The rates of septic shock, norepinephrine administration, renal replacement, mechanical ventilator therapy, and reoperation, the Simplified Acute Physiology Score-3 (SAPS3), and the Sepsis-related Organ Failure Assessment (SOFA) score were greater in non-survivors. DNI on day 3 was better than the other laboratory variables for predicting mortality. DNI was correlated with the SAPS3 (r = .46, p = .00) and SOFA score (r = .45, p = .00). The optimal cut-off DNI for predicting mortality was 7.8% (sensitivity: 77.3%; specificity: 95.9%). In receiver-operating characteristic curve analysis, DNI on day 3 was the best indicator of mortality (area under the curve: .880; 95% confidence interval: .80–.96).


Our results indicate that DNI is better than other laboratory variables for predicting postoperative mortality in patients with sepsis caused by peritonitis. DNI > 7.8% on day 3 was a reliable predictor of postoperative mortality.

Publisher URL: http://journals.plos.org/plosone/article

DOI: 10.1371/journal.pone.0182325

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