Ann Surg Treat Res.  2017 Nov;93(5):272-276. 10.4174/astr.2017.93.5.272.

Which patients with intestinal obstruction need surgery? The delta neutrophil index as an early predictive marker

• Lee H
• Kim IK
• Ju MK

• KMID: 2393993
• DOI: http://doi.org/10.4174/astr.2017.93.5.272

Abstract

PURPOSE
Predicting the need for surgical intervention among patients with intestinal obstruction is challenging. The delta neutrophil index (DNI) has been suggested as a useful marker of immature granulocytes, which indicate an infection or sepsis. In this study, we evaluated the impact of the DNI as an early predictor of operation among patients with intestinal obstruction.
METHODS
A total of 171 patients who were diagnosed with postoperative intestinal obstruction were enrolled in this study. Medical records, including data for the initial CRP level, WBC count, and DNI were reviewed. Receiver operating characteristic (ROC) curves were generated to clarify the optimal DNI cutoff values for predicting an operation.
RESULTS
Among the 171 patients, 38 (22.2%) needed surgical intervention. The areas under the initial CRP, WBC, and DNI ROC curves were 0.460, 0.449, and 0.543, respectively. The optimal cutoff value for predicting further surgical intervention according to the initial DNI level was 4.3%. The accuracy of the cutoff value was 74.9%, the sensitivity was 23.7%, and the specificity was 89.5% (positive predictive value, 23.7%; negative predictive value, 89.5%). In the multivariate analysis, initial DNI levels ≥ 4.3% were significantly associated with surgical intervention (odd ratio, 3.092; 95% confidence interval, 1.072-8.918; P = 0.037).
CONCLUSION
The initial DNI level in patients with intestinal obstruction may be a useful predictor for determining the need for surgical intervention.

Keyword

Delta neutrophil index; Postoperative intestinal obstruction; Surgical intervention

MeSH Terms

Granulocytes
Humans
Intestinal Obstruction*
Medical Records
Multivariate Analysis
Neutrophils*
ROC Curve
Sensitivity and Specificity
Sepsis

Figure

• 

  Fig. 1 Initial level of delta neutrophil index (DNI) in patients with or without surgical intervention.

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  Fig. 2 Receiver operating characteristic (ROC) curve of delta neutrophil index (DNI) in enrolled patients. AUC, area under the ROC curve.

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