Th e Accuracy of Delta Neutrophil Index as a Marker of Sepsis Severity Level Compare to Serum Amyloid A

https://doi.org/10.22146/actainterna.50906

Silvikarina Erfanti Dewi Halim(1*), Rizka Humardewayanti Asdie(2), Doni Priambodo(3)

(1) 
(2) 
(3) 
(*) Corresponding Author

Abstract


Background. Early diagnosis of infection before its progression to become organ dysfunction or circulation failure has an important clinical effect and critical patient outcome. Diagnostic modality used as a gold standard on diagnosing sepsis condition still relies on microbe culture. Microbial culture needed a long duration to grow bacteria in high numbers be identified. The upcoming alternative diagnostic modality used as a marker of sepsis severity level was Delta Neutrophil Index (DNI) and Serum Amyloid A (SAA). There were no references to compare the accuracy of DNI and SAA as a marker of sepsis severity level.

Methods. 45 study subjects were patients with sepsis and severe sepsis or septic shock first known when first come to the ER or underwent treatment in the inpatient unit, ICU (Intensive Care Unit) or IMC (Intermediate Care) Sardjito’s Hospital that fulfilled the inclusion and exclusion criteria. The independent variable was DNI and the dependent variable was sepsis severity level. All of blood samples from septic patient undergo DNI and SAA test. Distributed data used the Kolmogorov-Smirnov test. DNI and SAA accuracy used sensitivity, specificity, positive predictive value, negative predictive value, like hood ratio and receiver-operating characteristics (ROC) curve.

Results. The study consisted of 45 study subjects. The mean age was 52.98 years. The mean of SAA in this study was 54.39 ± 45.53 mg/L, while the mean of DNI in this study was 12.47 ± 8.79 %. Cut off point DNI 6.85% with value of sensitivity 93%, specificity 70%, positive predictive value (PPV) 79.31%, and negative predictive value (NPV) 87.5%, like hood ratio for a positive test result (LR+) (PLR) 14.28 and like hood ratio for a negative test result (LR-) (NLR) 3.3. Cut off for SAA 54.93 mg/L with value of sensitivity 60%, specificity 56%, positive predictive value (PPV) 52%, negative predictive value (NPV) 64%, like hood ratio for a positive test result (LR+) (PLR) 1.36 and likelihood ratio for a negative test result (LR-) (NLR) 0.71.

Conclusions. DNI has better diagnostic accuracy value as a marker of sepsis severity level than SAA.

Keywords. Sepsis, sepsis severity level, Delta Neutrophil Index (DNI), Serum Amyloid A (SAA)


Keywords


Sepsis, sepsis severity level, Delta Neutrophil Index (DNI), Serum Amyloid A (SAA)

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References

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992 Jun;20(6):864-74

Angus, Linde-Zwirble WT, Lidicker J, Clermont G, etal. 2001. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul;29(7):1303-10

Armstrong MA, Blot S, Bodey, et al. 2006. Sepsis Management. : 167-171

Arnon S, Litmanovitz I, Regev RH, et al. Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis. J. Perinatol. 27(5), 297–302 (2007)

Cetinkaya M, Ozkan H, Koksal N, et al. 2009. Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants.J. Perinatol. 29(3), 225–231

Cornbleet PJ. 2002.Clinical utility of the band count.Clin Lab Med, 22(1):101-136.

Dremsizov TT, Kellum JA, Angus DC, 2004. Incidence and definition of sepsis and associated organ dysfunction. Int J Artif Organs;27:352-359.

EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Medicine April 2004, Volume 30, Issue 4, pp 580–588

Guntur A H. 2007.Sepsis. Dalam: Buku Ajar Ilmu Penyakit Dalam. Sudoyo AW, Setiyohadi B, Alwi I, dkk (Editor). Jakarta. Pusat Penerbitan Ilmu Penyakit Dalam FK UI; hal.1862-5

Kim HW, Ku NS, Jeong SJ, et al. 2011. Usefulness of Delta Neutrophil Index in automated immature granulocyte counts for assessing prognosis of patients with bacteremia. Poster abstract session: Diagnosti procedures in clinical pratise-IDSA annual meeting: Boston.

Lannergard A, Larsson A, Friman G, Ewald U. 2008.Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections. Acta Paediat. 97(8), 1061–5

Martin, Mannino DM, Eaton S, Moss M. 2003. The Epidemiology of Sepsis in the United States from 1979 through 2000. http://www.nejm.org/doi/pdf/10.1056/NEJMoa022139

Padkin A1, Goldfrad C, Brady AR, et al. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med. 2003 Sep;31(9):2332-8

Park, Hoon Byung, Moo Suk Park, Won Jai Jung et al. 2011. Delta Neutrophil Index as an early marker of disease severity in critically ill patients with sepsis.http://www.biomedcentral.com/1471-2334/11/299.

Pincus MR, McPherson RA, Henry JB. 2007. Henry's Clinical Diagnosis and Management by Laboratory Methods. Saunders Elsevier. ISBN 1-4160-0287-1a

Purba. 2012. Procalcitonin sebagai marker dan hubungannya dengan derajat keparahan sepsis. Tesis, Universitas Sumatra Utara.

Pyo J.O, Jang M.H, Kwon Y.K, et al. 2005. Autophagy is essential for mitochondrial clearance in mature T lymphocyte. J Immunol: 182,4046-4055

S. Arnon, I. Litmanovitz, R. Regev, et al. 2005. Serum amyloid A protein is a useful inflammatory marker during late-onset sepsis in preterm infants. Biology of the Neonate, vol. 87, no. 2; 105–10



DOI: https://doi.org/10.22146/actainterna.50906

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