응급진료센터에 내원한 지역획득 폐렴 환자에서 델타뉴트로필을 이용한 패혈성 쇼 크 발생 예측의 유용성 = Usefulness of Delta Neutrophil Index in Prediction of Septic Shock in Patients with Community-acquired Pneumonia

다국어 초록 (Multilingual Abstract)

Purpose: The delta neutrophil index (DNI) corresponds to the calculated immature granulocyte counts and the severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for septic shock in patients with severe community-acquired pneumonia in emergency department.
Methods: The present study was a retrospective analysis of patients with pathologically confirmed communityacquired pneumonia from December 2011 to February 2012 at a hospital. The DNI was automatically calculated as a subset of routine complete blood count test. The diagnostic performance of DNI for septic shock in patients with community-acquired pneumonia was evaluated.
Results: During the study period, 105 patients were enrolled. Among them, 27 patients (25.7%) were confirmed as having septic shock according to predetermined criteria.
The initial value of DNI was significantly higher in septic shock group than in non-shock group (8.7% vs 2.3%,p=0.008). The peak value of DNI was also significantly higher in septic shock group (18.6% vs 4%, p<0.001). The sensitivity and specificity of the initial and peak DNI values for predicting septic shock in patients with communityacquired pneumonia were 48.2%, 96.2%, 74.1%, and 87.2%, respectively, at initial and peak cutoff levels of 11.2% and 8.7% with an area under the curve (AUC) of 0.72 and 0.81 on the Receiver Operating Characteristic (ROC) curve. The AUC to predict septic shock was 0.74 for the CURB-65 scale. The AUC was significantly increased when peak DNI was added to CURB-65 scale (p=0.007).
Conclusion: This study suggested that the DNI is associated with septic shock in patients with community-acquired pneumonia.
Clinically, the peak value of DNI added to CURB-65scale could improve predictable performance of septic shock in patients with community-acquired pneumonia.

참고문헌 (Reference)

1 Colice GL, "Treatment costs of community-acquired pneumonia in an employed population" 125 : 2140-2145, 2004

2 Mira JP, "The role of biomarkers in community-acquired pneumonia: predicting mortality and response to adjunctive therapy" 12 (12): S5-, 2008

3 Pereira JM, "Severe sepsis in community-acquired pneumonia-early recognition and treatment" 23 : 412-419, 2012

4 Ansari-Lari MA, "Relationship to infection and sepsis" 120 : 795-799, 2003

5 이재혁, "Red cell distribution width as a prognostic marker in patients with community-acquired pneumonia" W B SAUNDERS CO-ELSEVIER INC 31 (31): 72-79, 2013

6 Fine MJ, "Prognosis and outcomes of patients with community-acquired pneumonia : a meta-analysis" 275 : 134-141, 1996

7 Kratz A, "Enumeration of nucleated red blood cells with the ADVIA 2120 Hematology System : an International Multicenter Clinical Trial" 12 : 63-70, 2006

8 Kumar A, "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock" 34 : 1589-1596, 2006

9 Kim HW, "Delta neutrophil index: Could it predict mortality in patients with bacteraemia?" Taylor & Francis 44 : 475-480, 2012

10 남정현, "Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis" INST CLINICAL SCIENCE INC 38 (38): 241-246, 2008

11 Park BH, "Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis" BIOMED CENTRAL LTD 11 : 299-, 2011

12 Seok Y, "DELTA NEUTROPHIL INDEX: A PROMISING DIAGNOSTIC AND PROGNOSTIC MARKER FOR SEPSIS" LIPPINCOTT WILLIAMS & WILKINS 37 : 242-246, 2012

13 Pereira JM, "Assessing severity of patients with community-acquired pneumonia" 33 : 272-283, 2012

14 이재혁, "Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia" W B SAUNDERS CO 26 (26): 287-294, 2011