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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): 403-412.
응급진료센터에 내원한 기계적 장폐색 환자에서 델타 뉴트로필 지표를 이용한 30일 사망률 예측의 유용성
한세희1, 유제성1, 정성필1, 이혜선2, 공태영1, 김지훈1, 고동률1, 주영선1, 좌민홍1, 박인철1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 연구부 통계지원팀
Usefulness of Delta Neutrophil Index to Predict 30-day Mortality in Patients with Mechanical Bowel Obstruction
Sehee Han1, Je Sung You1, Sung Phil Chung1, Hye Sun Lee2, Taeyoung Kong1, Ji Hoon Kim1, Dongryul Ko1, Youngseon Joo1, Minhong Choa1, Incheol Park1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Taeyoung Kong ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: grampian@yuhs.ac,
Received: June 14, 2017; Revised: June 14, 2017   Accepted: August 21, 2017.  Published online: October 31, 2017.
Mechanical bowel obstruction (MBO) is a common emergency problem resulting in high morbidity and mortality. The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with infection and/or systemic inflammation. This study was conducted to investigate the relationship between DNI and 30-day mortality in patients with MBO.
We retrospectively identified consecutive patients (>18 years old) with MBO admitted to the emergency department from January 1, 2013 to April 30, 2015. The diagnosis of MBO was confirmed using clinical and radiological findings. The DNI was determined on each day of hospitalization. The outcome of interest was the 30-day mortality and the prognostic value of DNI for 30-day mortality was ascertained by Cox proportional hazards model analysis.
A total of 518 patients with MBO were included in this study. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR], 1.080; 95% confidence interval [CI], 1.036-1.126; p<0.001) was a strong independent predictor of short-term mortality. Among patients with MBO, a DNI >1.9% on admission (HR, 9.410; 95% CI, 2.671-33.145; p<0.001) was associated with increased 30-day mortality. Furthermore, the accuracy of DNI for predicting 30-day mortality was superior to that of other parameters.
The DNI can be measured rapidly and simply on emergency department admission without additional cost or time burden. Increased DNI values are associated with 30-day mortality in patients with MBO.
Key words: Delta neutrophil index, Mechanical bowel obstruction, Mortality
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