Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis

One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer.Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure.DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.Sepsis is the leading cause of death in intensive care units (ICUs) today. In spite of recent advances in antibiotic therapy and general critical care practices, including early goal-directed treatment for septic shock [1], mortality of patients with severe sepsis/septic shock is still substantial [2,3]. Early diagnosis of infection and sepsis before it progresses to organ dysfunction or circulatory failure has crucial impact on the clinical course and outcome of critically ill patients [4]. However, because sepsis is not a final diagnosis, but a clinical syndrome encompassing many heterogeneous conditions with regard