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Delta Neutrophil Index for the Prediction of the Development of Sepsis-Induced Acute Kidney Injury in the Emergency Department

Kim, Ji Hoon*; Park, Yoo Seok*; Yoon, Chang-Yun; Lee, Hye Sun; Kim, Sinae; Lee, Jong Wook§; Kong, Taeyoung*,||; You, Je Sung*; Park, Jong Woo; Chung, Sung Phil*

doi: 10.1097/SHK.0000000000001299
Clinical Science Aspects
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Background and Purpose: The early prediction of acute kidney injury (AKI) in sepsis and provision of timely treatment may improve outcomes. We investigated the efficacy of the delta neutrophil index (DNI)—which reflects the fraction of immature granulocytes—in predicting sepsis-induced AKI and 30-day mortality in cases of severe sepsis or septic shock.

Methods: This retrospective, observational cohort study was performed with patients prospectively integrated in a critical pathway of early-goal-directed therapy /SEPSIS. We analyzed adult sepsis patients admitted to the emergency department with normal kidney function or stage 1 disease, based on the Acute Kidney Injury Network classification, between January 1, 2014 and September 30, 2017. The outcomes were the development of sepsis-induced severe AKI within 7 days and 30-day mortality.

Results: A total of 346 patients were enrolled. An increase in the DNI values at Time-0 (odds ratio [OR], 1.060; P < 0.001) and Time-12 (OR, 1.086; P < 0.001) were strong independent predictors of severe AKI development. The increasing predictability of AKI was closely associated with a DNI ≥14.0% at Time-0 (OR, 7.238; P < 0.001) and ≥13.3% at Time-12 (OR, 18.089; P < 0.001). The development of severe AKI was an independent predictor of 30-day mortality (hazard ratio: 25.2, P < 0.001).

Conclusion: Higher DNI values are independent predictors of severe AKI development and 30-day mortality in sepsis. Physicians can use the DNI to quickly determine the severity of sepsis and initial treatment strategies without additional costs and effort.

*Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea

Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea

§Department of Laboratory Medicine, Konyang University Hospital, Konyang, Republic of Korea

||Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea

Department of Emergency Medicine, Kosin University College of Medicine, Busan, Republic of Korea

Address reprint requests to Je Sung You, MD, PhD, Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, Republic of Korea. E-mail: youjsmd@yuhs.ac, Co-correspondence: Taeyoung Kong, MD, Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, Republic of Korea. E-mail: grampian@yuhs.ac

Received 17 June, 2018

Revised 10 July, 2018

Accepted 16 November, 2018

JHK and YSP contributed equally to this work.

JSY was supported by the Basic Science Research Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2018R1C1B6006159). In addition, JSY received research funding from Siemens Health Care. However, the funds did not exceed $10,000/year. The funding bodies had no role in the design, collection, analysis, or interpretation of this study.

JHK TK, YSP, JWL, and JSY conceived and planned the study, and were mainly responsible for the design of the study. JHK, TK, YSP, and JSY collected data. JHK, TK, SK, HSL, CYY, SPC, and JSY were mainly responsible for the data analysis. JHK, TK, YSP, and JSY wrote the first draft of the manuscript. All the authors contributed to the interpretation of the findings and reviewed the manuscript. JHK, TK, YSP, JWP, SK, HSL, JWL, C-YY, SPC, and JSY reviewed the statistical analyses and made changes to the contents of the manuscript. All authors also provided intellectual contributions to the manuscript.

The authors report no conflicts of interest.

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© 2019 by the Shock Society