Delta neutrophil index as a promising prognostic marker of emergent surgical intervention for acute diverticulitis in the emergency department
Early identification of patients with acute diverticulitis who require emergent surgical intervention in the emergency department (ED) is important to the physician. Although computed tomography (CT) has an important role in evaluating the severity of diverticulitis, its findings alone may not predi...
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| description | Early identification of patients with acute diverticulitis who require emergent surgical intervention in the emergency department (ED) is important to the physician. Although computed tomography (CT) has an important role in evaluating the severity of diverticulitis, its findings alone may not predict the need for emergent surgical intervention in all patients with acute diverticulitis in the ED. Serum inflammation markers may help to differentiate severity of acute diverticulitis and predict the need for surgical intervention in clinical practice. No information is currently available on the clinical usefulness of the delta neutrophil index (DNI), with respect to the prediction of emergent surgical intervention in patients with acute diverticulitis at the ED.
This was a retrospective observational study of consecutive adult patients with acute diverticulitis confirmed by CT in the ED, between January 2014 and December 2016. Recruited patients were divided into two groups: emergent surgical intervention and no surgical intervention. The following laboratory serum parameters were examined in the ED: DNI value, C-reactive protein (CRP) levels, white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). The patients were also examined for the presence or absence of complications by CT.
A total of 132 patients were finally included in the study, with the emergent surgical intervention group constituting 52 patients. The median DNI value, CRP levels, neutrophil count, and NLR were significantly higher in the emergent surgical intervention group than in the no surgical intervention group. The area under the curve for predicting emergent surgical intervention, using the DNI was significantly higher than that of CRP levels, neutrophil count, or NLR. Moreover, the combination of initial DNI and CT was most powerful diagnostic modality.
DNI values measured at the ED combined with CT were good predictors for emergent surgical intervention in acute diverticulitis. If the DNI value is greater than 0.7% and complications in CT are suspected in patients suspected to have acute diverticulitis, the need for emergent surgical intervention should be considered carefully in the ED. |
| doi_str_mv | 10.1371/journal.pone.0187629 |
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This was a retrospective observational study of consecutive adult patients with acute diverticulitis confirmed by CT in the ED, between January 2014 and December 2016. Recruited patients were divided into two groups: emergent surgical intervention and no surgical intervention. The following laboratory serum parameters were examined in the ED: DNI value, C-reactive protein (CRP) levels, white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). The patients were also examined for the presence or absence of complications by CT.
A total of 132 patients were finally included in the study, with the emergent surgical intervention group constituting 52 patients. The median DNI value, CRP levels, neutrophil count, and NLR were significantly higher in the emergent surgical intervention group than in the no surgical intervention group. The area under the curve for predicting emergent surgical intervention, using the DNI was significantly higher than that of CRP levels, neutrophil count, or NLR. Moreover, the combination of initial DNI and CT was most powerful diagnostic modality.
DNI values measured at the ED combined with CT were good predictors for emergent surgical intervention in acute diverticulitis. If the DNI value is greater than 0.7% and complications in CT are suspected in patients suspected to have acute diverticulitis, the need for emergent surgical intervention should be considered carefully in the ED.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0187629</identifier><identifier>PMID: 29091955</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute Disease ; Adult ; Age ; Aged ; Antibiotics ; Biology and Life Sciences ; Biomarkers - blood ; Blood ; C-reactive protein ; Care and treatment ; CAT scans ; Clinical medicine ; Clinical trials ; Complications ; Computed tomography ; Data collection ; Diagnosis ; Diagnostic systems ; Diverticulitis ; Diverticulitis - blood ; Diverticulitis - diagnostic imaging ; Diverticulitis - surgery ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Female ; Granulocytes ; Hematology ; Hospital emergency services ; Hospitals ; Humans ; Inflammation ; Intervention ; Leukocytes ; Male ; Medical prognosis ; Medical records ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Neutrophilia ; Neutrophils ; Neutrophils - pathology ; Patients ; Predictions ; Prognosis ; Proteins ; Research and Analysis Methods ; Retrospective Studies ; Sepsis ; Surgery ; Tomography, X-Ray Computed</subject><ispartof>PloS one, 2017-11, Vol.12 (11), p.e0187629-e0187629</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Kang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Kang et al 2017 Kang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-dfe1bff8de6c68e7b186d269e6233238ed15249960bb7a0412fe56abf8923eea3</citedby><cites>FETCH-LOGICAL-c692t-dfe1bff8de6c68e7b186d269e6233238ed15249960bb7a0412fe56abf8923eea3</cites><orcidid>0000-0001-9897-4273</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665552/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665552/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29091955$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Green, John</contributor><creatorcontrib>Kang, Hee Seung</creatorcontrib><creatorcontrib>Cha, Yong Sung</creatorcontrib><creatorcontrib>Park, Kyung Hye</creatorcontrib><creatorcontrib>Hwang, Sung Oh</creatorcontrib><title>Delta neutrophil index as a promising prognostic marker of emergent surgical intervention for acute diverticulitis in the emergency department</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Early identification of patients with acute diverticulitis who require emergent surgical intervention in the emergency department (ED) is important to the physician. Although computed tomography (CT) has an important role in evaluating the severity of diverticulitis, its findings alone may not predict the need for emergent surgical intervention in all patients with acute diverticulitis in the ED. Serum inflammation markers may help to differentiate severity of acute diverticulitis and predict the need for surgical intervention in clinical practice. No information is currently available on the clinical usefulness of the delta neutrophil index (DNI), with respect to the prediction of emergent surgical intervention in patients with acute diverticulitis at the ED.
This was a retrospective observational study of consecutive adult patients with acute diverticulitis confirmed by CT in the ED, between January 2014 and December 2016. Recruited patients were divided into two groups: emergent surgical intervention and no surgical intervention. The following laboratory serum parameters were examined in the ED: DNI value, C-reactive protein (CRP) levels, white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). The patients were also examined for the presence or absence of complications by CT.
A total of 132 patients were finally included in the study, with the emergent surgical intervention group constituting 52 patients. The median DNI value, CRP levels, neutrophil count, and NLR were significantly higher in the emergent surgical intervention group than in the no surgical intervention group. The area under the curve for predicting emergent surgical intervention, using the DNI was significantly higher than that of CRP levels, neutrophil count, or NLR. Moreover, the combination of initial DNI and CT was most powerful diagnostic modality.
DNI values measured at the ED combined with CT were good predictors for emergent surgical intervention in acute diverticulitis. If the DNI value is greater than 0.7% and complications in CT are suspected in patients suspected to have acute diverticulitis, the need for emergent surgical intervention should be considered carefully in the ED.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers - blood</subject><subject>Blood</subject><subject>C-reactive protein</subject><subject>Care and treatment</subject><subject>CAT scans</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Data collection</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Diverticulitis</subject><subject>Diverticulitis - blood</subject><subject>Diverticulitis - diagnostic imaging</subject><subject>Diverticulitis - surgery</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Granulocytes</subject><subject>Hematology</subject><subject>Hospital emergency services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Intervention</subject><subject>Leukocytes</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Neutrophilia</subject><subject>Neutrophils</subject><subject>Neutrophils - pathology</subject><subject>Patients</subject><subject>Predictions</subject><subject>Prognosis</subject><subject>Proteins</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7jr6D0QDgujFjEnaZJobYVm_BhYW_LoNaXvSydo2NUmH3T_hbzbd6SxT2QvpRcPJ877JOScnSZ4TvCLpmry7soPrVLPqbQcrTPI1p-JBckpESpec4vTh0fokeeL9FcYszTl_nJxQgQURjJ0mfz5AExTqYAjO9lvTINNVcI2URwr1zrbGm64eV3VnfTAlapX7BQ5ZjaAFV0MXkB9cbUo1agO4XQwZ2yFtHVLlEABVZgcuaofGBOMjhcIWDvLyBlXQKxfaqHuaPNKq8fBs-i-SH58-fj__sry4_Lw5P7tYllzQsKw0kELrvAJe8hzWBcl5RbkATtOUpjlUhNFMCI6LYq1wRqgGxlWhc0FTAJUukpd7376xXk6l9DLWJOc4x9FjkWz2RGXVleydiXnfSKuMvA1YV0s15tSAJFirSgjFCkyzDENOONM8zagolWAUotf76bShaKEqY6JONTPT-U5ntrK2O8k4Z4yNl3kzGTj7ewAfZOxLCU2jOrDD7b1jq0m2ZhF99Q96f3YTVauYgOm0jeeWo6k8YyRWUvAsj9TqHip-FbSmjO9OmxifCd7OBJEJcB1qNXgvN9--_j97-XPOvj5it6CasPW2GcZ35udgtgdLZ713oO-KTLAcx-ZQDTmOjZzGJspeHDfoTnSYk_QvndUWDw</recordid><startdate>20171101</startdate><enddate>20171101</enddate><creator>Kang, Hee Seung</creator><creator>Cha, Yong Sung</creator><creator>Park, Kyung Hye</creator><creator>Hwang, Sung Oh</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-9897-4273</orcidid></search><sort><creationdate>20171101</creationdate><title>Delta neutrophil index as a promising prognostic marker of emergent surgical intervention for acute diverticulitis in the emergency department</title><author>Kang, Hee Seung ; Cha, Yong Sung ; Park, Kyung Hye ; Hwang, Sung Oh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-dfe1bff8de6c68e7b186d269e6233238ed15249960bb7a0412fe56abf8923eea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Antibiotics</topic><topic>Biology and Life Sciences</topic><topic>Biomarkers - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Hee Seung</au><au>Cha, Yong Sung</au><au>Park, Kyung Hye</au><au>Hwang, Sung Oh</au><au>Green, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delta neutrophil index as a promising prognostic marker of emergent surgical intervention for acute diverticulitis in the emergency department</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-11-01</date><risdate>2017</risdate><volume>12</volume><issue>11</issue><spage>e0187629</spage><epage>e0187629</epage><pages>e0187629-e0187629</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Early identification of patients with acute diverticulitis who require emergent surgical intervention in the emergency department (ED) is important to the physician. Although computed tomography (CT) has an important role in evaluating the severity of diverticulitis, its findings alone may not predict the need for emergent surgical intervention in all patients with acute diverticulitis in the ED. Serum inflammation markers may help to differentiate severity of acute diverticulitis and predict the need for surgical intervention in clinical practice. No information is currently available on the clinical usefulness of the delta neutrophil index (DNI), with respect to the prediction of emergent surgical intervention in patients with acute diverticulitis at the ED.
This was a retrospective observational study of consecutive adult patients with acute diverticulitis confirmed by CT in the ED, between January 2014 and December 2016. Recruited patients were divided into two groups: emergent surgical intervention and no surgical intervention. The following laboratory serum parameters were examined in the ED: DNI value, C-reactive protein (CRP) levels, white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). The patients were also examined for the presence or absence of complications by CT.
A total of 132 patients were finally included in the study, with the emergent surgical intervention group constituting 52 patients. The median DNI value, CRP levels, neutrophil count, and NLR were significantly higher in the emergent surgical intervention group than in the no surgical intervention group. The area under the curve for predicting emergent surgical intervention, using the DNI was significantly higher than that of CRP levels, neutrophil count, or NLR. Moreover, the combination of initial DNI and CT was most powerful diagnostic modality.
DNI values measured at the ED combined with CT were good predictors for emergent surgical intervention in acute diverticulitis. If the DNI value is greater than 0.7% and complications in CT are suspected in patients suspected to have acute diverticulitis, the need for emergent surgical intervention should be considered carefully in the ED.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29091955</pmid><doi>10.1371/journal.pone.0187629</doi><tpages>e0187629</tpages><orcidid>https://orcid.org/0000-0001-9897-4273</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Age Aged Antibiotics Biology and Life Sciences Biomarkers - blood Blood C-reactive protein Care and treatment CAT scans Clinical medicine Clinical trials Complications Computed tomography Data collection Diagnosis Diagnostic systems Diverticulitis Diverticulitis - blood Diverticulitis - diagnostic imaging Diverticulitis - surgery Emergency medical care Emergency medical services Emergency Service, Hospital Female Granulocytes Hematology Hospital emergency services Hospitals Humans Inflammation Intervention Leukocytes Male Medical prognosis Medical records Medicine Medicine and Health Sciences Middle Aged Neutrophilia Neutrophils Neutrophils - pathology Patients Predictions Prognosis Proteins Research and Analysis Methods Retrospective Studies Sepsis Surgery Tomography, X-Ray Computed |
| title | Delta neutrophil index as a promising prognostic marker of emergent surgical intervention for acute diverticulitis in the emergency department |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T15%3A05%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Delta%20neutrophil%20index%20as%20a%20promising%20prognostic%20marker%20of%20emergent%20surgical%20intervention%20for%20acute%20diverticulitis%20in%20the%20emergency%20department&rft.jtitle=PloS%20one&rft.au=Kang,%20Hee%20Seung&rft.date=2017-11-01&rft.volume=12&rft.issue=11&rft.spage=e0187629&rft.epage=e0187629&rft.pages=e0187629-e0187629&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0187629&rft_dat=%3Cgale_plos_%3EA512699648%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1958608032&rft_id=info:pmid/29091955&rft_galeid=A512699648&rft_doaj_id=oai_doaj_org_article_10fad99a5b02440e8165f63429ca952e&rfr_iscdi=true |