Key result
Postoperative day 1 Delta neutrophil index was an independent predictor of mortality in trauma patients who underwent emergent abdominal surgery (OR 1.118).
Why the study?
Delta neutrophil index can be used as a biomarker for infection to predict patient outcomes, but its relationship with clinical outcomes in trauma patients undergoing abdominal surgery needed investigation.
Case-Control (n=169)
No
Odds Ratio: 1.118 (95% CI 1.028–1.215)
p-value: p=0.009
May aid postoperative risk stratification in trauma surgery; leaves open prospective validation before clinical adoption.
BACKGROUND: Delta neutrophil index (DNI) can be used as a biomarker for infection to predict patient outcomes. We aimed to investigate the relationship between DNI and clinical outcomes in trauma patients who underwent abdominal surgery. MATERIALS AND METHODS: We retrospectively analyzed injured patients who underwent emergent abdominal surgery in the regional trauma center of Wonju Severance Christian Hospital between March 2016 and May 2018. Patient characteristics, operation type, preoperative and postoperative laboratory findings, and clinical outcomes were evaluated. Logistic regression analysis was performed for risk factors associated with mortality. RESULTS: Overall, 169 patients (mean age, 53.8 years; 66.3% male) were enrolled in this study, of which 19 (11.2%) died. The median injury severity score (ISS) was 12. The non-survivors had a significantly higher ISS [25(9-50) vs. 10(1-50), p<0.001] and serum lactate level (9.00±4.10 vs. 3.04±2.23, p<0.001) and more frequent shock (63.2% vs 23.3%, p<0.001) and solid organ injury (52.6% vs. 25.3%, p = 0.013) than the survivors. There were significant differences in postoperative DNI between the two groups (p<0.009 immediate post-operation, p = 0.001 on postoperative day 1 [POD1], and p = 0.013 on POD2). Logistic regression analysis showed that the independent factors associated with mortality were postoperative lactate level (odds ratio [OR] 1.926, 95% confidence interval [CI] 1.101-3.089, p = 0.007), postoperative sequential organ failure assessment score (OR 1.593, 95% CI 1.160-2.187, p = 0.004), and DNI on POD1 (OR 1.118, 95% CI 1.028-1.215, p = 0.009). The receiver operating characteristics curve demonstrated that the area under the curve of DNI on POD1 was 0.887 (cut-off level: 7.1%, sensitivity 85.7%, and specificity 84.4%). CONCLUSIONS: Postoperative DNI may be a useful biomarker to predict mortality in trauma patients who underwent emergent abdominal surgery.
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Bang et al. (2020) conducted a case-control in Trauma requiring emergent abdominal surgery (n=169). Delta neutrophil index (DNI) vs. Lower DNI was evaluated on Postoperative mortality (OR 1.118, 95% CI 1.028-1.215, p=0.009). Postoperative day 1 Delta neutrophil index was an independent predictor of mortality in trauma patients who underwent emergent abdominal surgery (OR 1.118).
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