Delta Neutrophil Index as a Prognostic Marker in the Pediatric Intensive Care Unit
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors. Methods: A total of 516 children admitted to Severance Children’s Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission. Results: The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%. Conclusions: The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.
Abstract
Background: The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors. Methods: A total of 516 children admitted to Severance Children’s Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission. Results: The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%. Conclusions: The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.
참고문헌 (24)
- 황희승, "단일 병원에서 소아 중환자의 예후인자 예측을 위한 PIM2 (pediatric index of mortality 2)와 PRIMS III (pediatric risk of mortality)의 유효성 평가 - 후향적 조사 -", Korean Journal of Pediatrics, 51(11), pp.1158~1164 (2008), 대한소아과학회
- Leteurtre S, "Validation of the paediatric logistic organ dysfunction (PELOD)score: prospective, observational, multicentre study", Lancet, 362, pp.192~197 (2003)
- Taori RN, "Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU", Indian J Pediatr, 77, pp.267~271 (2010)
- Sankar J, "Do interventions in an ICU affect the predictive ability of pediatric index of mortality and pediatric index of mortality-2 scores in a tertiary care hospital?", Pediatr Crit Care Med, 14, pp.e70~e76 (2013)
- Wolfler A, "The importance of mortality risk assessment:Validation of the pediatric index of mortality 3 score", Pediatr Crit Care Med, 17, pp.251~256 (2016)
- Lobo SM, "C-reactive protein levels correlate with mortality and organ failure in critically ill patients", Chest, 123, pp.2043~2049 (2003)
- Vanderschueren S, "Thrombocytopenia and prognosis in intensive care", Crit Care Med, 28, pp.1871~1876 (2000)
- 김윤희, "소아 중환자의 예후 인자로서 혈소판 감소증과 변화 양상의 유용성", The Korean Journal of Critical Care Medicine, 28(2), pp.93~100 (2013), 대한중환자의학회
- Jensen JU, "Procalcitonin increase in early identification of critically ill patients at high risk of mortality", Crit Care Med, 34, pp.2596~2602 (2006)
- Devakonda A, "Transthyretin as a marker to predict outcome in critically ill patients", Clin Biochem, 41, pp.1126~1130 (2008)
- Abidi K, "Eosinopenia, an early marker of increased mortality in critically ill medical patients", Intensive Care Med, 37, pp.1136~1142 (2011)
- Nahm CH, "Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis", Ann Clin Lab Sci, 38, pp.241~246 (2008)
- Harris N, "The ADVIA 2120hematology system: flow cytometry-based analysis of blood and body fluids in the routine hematology laboratory", Lab Hematol, 11, pp.47~61 (2005)
- Kratz A, "Enumeration of nucleated red blood cells with the ADVIA 2120 Hematology System:an International Multicenter Clinical Trial", Lab Hematol, 12, pp.63~70 (2006)
- Park BH, "Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis", BMC Infect Dis, 11, pp.299~ (2011)
- 박희진, "Delta Neutrophil Index as an Early Marker for Differential Diagnosis of Adult-Onset Still’s Disease and Sepsis", Yonsei Medical Journal, 55(3), pp.753~759 (2014), 연세대학교의과대학[DOI]
- Ansari-Lari MA, "Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis", Am J Clin Pathol, 120, pp.795~799 (2003)
- Bernstein LH, "Measurement of granulocyte maturation may improve the early diagnosis of the septic state", Clin Chem Lab Med, 49, pp.2089~2095 (2011)
- Nigro KG, "Performance of an automated immature granulocyte count as a predictor of neonatal sepsis", Am J Clin Pathol, 123, pp.618~624 (2005)
- Pollack MM, "PRISM III:an updated Pediatric Risk of Mortality score", Crit Care Med, 24, pp.743~752 (1996)
- Slater A, "PIM2: a revised version of the Paediatric Index of Mortality", Intensive Care Med, 29, pp.278~285 (2003)
- Straney L, "Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*", Pediatr Crit Care Med, 14, pp.673~681 (2013)
- Hanley JA, "The meaning and use of the area under a receiver operating characteristic (ROC)curve", Radiology, 143, pp.29~36 (1982)
- Youden WJ, "Index for rating diagnostic tests", Cancer, 3, pp.32~35 (1950)