Yonsei Med J.  2014 May;55(3):753-759. 10.3349/ymj.2014.55.3.753.

Delta Neutrophil Index as an Early Marker for Differential Diagnosis of Adult-Onset Still's Disease and Sepsis

• Park HJ
• Ha YJ
• Pyo JY
• Park YB
• Lee SK
• Lee SW

• KMID: 2068687
• DOI: http://doi.org/10.3349/ymj.2014.55.3.753

Abstract

PURPOSE
To investigate clinical implications of delta neutrophil index (DNI) to discriminate adult onset Still's disease (AOSD) from sepsis.
MATERIALS AND METHODS
We reviewed the medical records of 13 patients with AOSD and 33 gender and age-matched patients with sepsis. In all subjects, microbial tests were performed to exclude or confirm sepsis. All laboratory data were measured two or three times during the first 3 days and represented by their mean levels. DNI was measured automatically by ADVIA 2120 for the first 3 days.
RESULTS
There were no significant differences in white blood cell counts, neutrophil proportion, erythrocyte sedimentation rate and C-reactive protein between two groups. AOSD patients had notably lower DNI than sepsis patients regardless of the presence of bacteremia or not. However, both DNI and ferritin were not significant independent factors for predicting sepsis in the multivariate logistic regression analysis. Meanwhile, the area under the receiver operating characteristic curve (AUROC) of DNI was slightly higher than that of ferritin. When we set DNI of 2.75% as the cut-off value for predicting sepsis, 11 (84.6%) of AOSD patients had a DNI value below 2.75% and 2 (15.4%) of them had a DNI over 2.75% (relative risk for sepsis 176).
CONCLUSION
We suggest that DNI may be a useful marker for differential diagnosis of AOSD from sepsis in the early phase as supplementary to ferritin.

Keyword

Adult onset still's disease; delta neutrophil index; sepsis

MeSH Terms

Adult
Biological Markers/*metabolism
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Neutrophils/*metabolism
Retrospective Studies
Sepsis/*diagnosis/metabolism
Still's Disease, Adult-Onset/*diagnosis/metabolism
Biological Markers

Figure

• 

  Fig. 1 Comparison of AUROC between delta neutrophil index (DNI) and ferritin. AUC of DNI was slightly higher than that of ferritin [0.896 (p<0.001) vs. 0.769 (p=0.008), respectively]. However, difference between the areas of DNI and ferritin was 0.0538, not statistically significant (p=0.68). AUC, area under curve.

• 

  Fig. 2 Sub-group analysis according to the presence of bacteremia. Patients in sepsis group were divided into 10 patients of sepsis without bacteremia group and 27 patients of sepsis with bacteremia group. The levels of WBC count (A), CRP (C) and ESR (D) had no difference between three groups. The delta neutrophil index (B) had significant difference in AOSD, non-bacteremia and bacteremia group (1.8±1.0 vs. 7.9±3.7 vs. 9.9±8.9, p<0.001 respectively). WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; AOSD, adult onset Still's disease.

• 

  Fig. 3 Proportion of patients with AOSD and sepsis according to delta neutrophil index. Patients in two groups were divided according to cut-off value of DNI, 2.75%. In patients with AOSD, 11 patients (84.6%) had DNI below 2.75% and 2 patients (15.4%) had DNI over 2.75%. In patients with sepsis, 1 patient (3.0%) had DNI below 2.75% and the rest of them (97.0%) showed DNI over 2.75% (p<0.001). AOSD, adult onset Still's disease; DNI, delta neutrophil index.

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