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J Korean Soc Emerg Med > Volume 28(5); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(5): 413-421.
응급실에 내원한 급성 신우신염 환자에서 장기 입원 기간 예측에 있어서 델타뉴트로필의 유용성
기동훈1, 유제성1, 이종욱2, 이혜선3, 이진애1, 정성필1, 공태영1, 주영선1, 고동률1
1연세대학교 의과대학 응급의학교실
2진천 성모병원 진단검사의학과
3연세대학교 의과대학 연구부 통계지원팀
Delta Neutrophil Index as a Predictive Factor of Prolonged Hospitalization in Emergency Department Patients with Acute Pyelonephritis
Dong Hune Key1, Je Sung You1, Jong Wook Lee2, Hye Sun Lee3, Jinae Lee1, Sung Phil Chung1, Tae Young Kong1, Young Seon Joo1, Dong Ryul Ko1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Korea
3Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Dong Ryul Ko ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: kkdry@yuhs.ac,
Received: June 1, 2017; Revised: June 1, 2017   Accepted: August 22, 1977.  Published online: October 31, 2017.
ABSTRACT
Purpose:
The delta neutrophil index (DNI) corresponds to evaluated immature granulocyte counts and severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for prolonged hospitalization in patients with acute pyelonephritis in the emergency department (ED).
Method:
We retrospectively analyzed medical records in two EDs and screened eligible adult patients who were admitted to the ED with acute pyelonephritis from July 2012 to July 2014. The DNI was calculated for all patients as a part of routine complete blood analysis, and diagnostic performance of DNI for predicting prolonged hospitalization (over 14 days) in patients with acute pyelonephritis (APN) was evaluated.
Results:
A total of 308 patients with APN were enrolled in the study. Among them, 89 patients (29.9%) were hospitalized for more than 14 days. The initial DNI value was significantly higher in patients with more than 14 days of hospitalization than in those with less than 14 days of hospitalization (6% vs. 2%, p<0.001). The peak value of DNI was also significantly higher in patients discharged after 14 days of hospitalization than in those discharged before 14 days (8% vs. 2%, p<0.001). Multivariate Cox proportional hazard models showed that a DNI of more than 6.3 on ED admission day (hazard ratio [HR], 0.314; 95% confidence interval [CI], 0.191-0.515, p<0.001) and on peak day (HR, 0.37; 95% CI, 0.244-0.562, p=0.028) was an independent risk factor for hospitalization over 14 days.
Conclusion:
DNI is potentially useful as an independent factor for predicting hospitalization for more than 14 days.
Key words: Pyelonephritis, Neutrophils, Hospitalization
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