• Ji Hoon Kim, Yoo Seok Park, Chang-Yun Yoon, Hye Sun Lee, Sinae Kim, Jong Wook Lee, Taeyoung Kong, Je Sung You, Jong Woo Park, and Sung Phil Chung.
• Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
• Shock. 2019 Oct 1; 52 (4): 414-422.

Background And PurposeThe early prediction of acute kidney injury (AKI) in sepsis and provision of timely treatment may improve outcomes. We investigated the efficacy of the delta neutrophil index (DNI)-which reflects the fraction of immature granulocytes-in predicting sepsis-induced AKI and 30-day mortality in cases of severe sepsis or septic shock.MethodsThis retrospective, observational cohort study was performed with patients prospectively integrated in a critical pathway of early-goal-directed therapy /SEPSIS. We analyzed adult sepsis patients admitted to the emergency department with normal kidney function or stage 1 disease, based on the Acute Kidney Injury Network classification, between January 1, 2014 and September 30, 2017. The outcomes were the development of sepsis-induced severe AKI within 7 days and 30-day mortality.ResultsA total of 346 patients were enrolled. An increase in the DNI values at Time-0 (odds ratio [OR], 1.060; P < 0.001) and Time-12 (OR, 1.086; P < 0.001) were strong independent predictors of severe AKI development. The increasing predictability of AKI was closely associated with a DNI ≥14.0% at Time-0 (OR, 7.238; P < 0.001) and ≥13.3% at Time-12 (OR, 18.089; P < 0.001). The development of severe AKI was an independent predictor of 30-day mortality (hazard ratio: 25.2, P < 0.001).ConclusionHigher DNI values are independent predictors of severe AKI development and 30-day mortality in sepsis. Physicians can use the DNI to quickly determine the severity of sepsis and initial treatment strategies without additional costs and effort.

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