• Hyunchul Kim, Taeyoung Kong, Sung Phil Chung, Jung Hwa Hong, Jong Wook Lee, Youngseon Joo, Dong Ryul Ko, Je Sung You, and Incheol Park.
• *Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea †Department of Health Insurance Research, National Health Insurance Service Ilsan Hospital, Gayang, Republic of Korea ‡Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Republic of Korea §Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
• Shock. 2016 Aug 24.

PurposeRecent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analysers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis.MethodsWe retrospectively analysed patients initially diagnosed with acute cholangitis at emergency department (ED) admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality.ResultsWe included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053-1.153; p < 0.001), day 1 (HR: 1.069; 95% CI: 1.018-1.122; p = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053-1.186; p < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI>4.9% at admission (HR: 5.632; 95% CI: 1.977-16.045; p = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666-37.302; p < 0.001) and higher DNI (>2.5%) on day 2 (HR, 16.942; 95% CI: 2.15-133.496; p = 0.007) were associated with increased 28-day mortality.ConclusionHigher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.

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