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J Korean Soc Emerg Med > Volume 32(4); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(4): 315-327.
뇌동맥류 파열에 의한 뇌지주막하 출혈 환자의 신경학적 예후 예측 인자로서 델타 뉴트로필 인덱스의 유용성
이용희1 , 유제성1 , 공태영1 , 이혜선2 , 전소영2 , 이종욱3 , 황현아1 , 이혁민4 , 정현수1 , 박인철1 , 정성필1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 연구부 통계지원팀
3건양대학교 의과대학 진단검사의학교실
4연세대학교 의과대학 진단검사의학교실
Usefulness of delta neutrophil index to predict neurologic outcome in patients with aneurysmal subarachnoid hemorrhage
Yonghee Lee1 , Je Sung You1 , Taeyoung Kong1 , Hye Sun Lee2 , Soyoung Jeon2 , Jong Wook Lee3 , Hyuna Hwang1 , Hyukmin Lee4 , Hyun Soo Chung1 , Incheol Park1 , Sung Phil Chung1
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
3Department of Laboratory Medicine, Konyang University Hospital, Daejeon, Korea
4Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Hyuna Hwang ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: HYUNA07@yuhs.ac,
Received: June 25, 2020; Revised: October 5, 2020   Accepted: October 19, 2020.  Published online: August 31, 2021.
Aneurysmal subarachnoid hemorrhage (SAH) is a common emergency condition, resulting in high morbidity and mortality. The delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, is significantly associated with systemic inflammation after infection or sterile injury. Aneurysmal SAH also leads to systemic inflammation after a brain injury. This study aimed to evaluate the relationship between the DNI and poor neurologic outcomes in patients with aneurysmal SAH.
We retrospectively identified patients (>18 years old) with aneurysmal SAH consecutively admitted to the emergency department (ED) between January 1, 2011, and November 30, 2018. The diagnosis of aneurysmal SAH was confirmed using clinical and radiological findings. DNI was determined at 0, 24, 48, and 72 hours after ED admission. The primary result was a poor neurologic outcome using the modified Rankin scale.
A total of 352 patients with aneurysmal SAH were included in this study. A multivariable logistic regression model revealed that a high value of DNI at 24 hours after ED admission was a strong independent predictor of poor neurologic outcome upon discharge (odds ratio [OR], 1.471; 95% confidence interval [CI], 1.081-2.001; P=0.014). Among patients with aneurysmal SAH, DNI >1.0% at 24 hours was significantly associated with poor neurologic outcomes upon discharge (OR, 5.037; 95% CI, 3.153-8.044; P<0.001).
DNI can be determined easily and rapidly after ED admission without any additional cost or time burden. A high DNI value at 24 hours after ED admission is significantly associated with a poor neurologic outcome upon discharge among patients with aneurysmal SAH.
Key words: Neutrophils; Aneurysmal subarachnoid hemorrhage; Inflammation; Prognosis
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