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      The delta neutrophil index (DNI) as a prognostic marker for mortality in adults with sepsis: a systematic review and meta-analysis

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          Abstract

          We performed a meta-analysis to seek evidence for the usefulness of the delta neutrophil index (DNI) as a prognostic blood biomarker for mortality in the early stage of sepsis in adults. A literature search was performed using criteria set forth in a predefined protocol. Studies of adults with sepsis that provided a DNI measurement and that had mortality as the outcome, were included. Review articles, editorials, and non-human studies were excluded. The methodological quality of identified studies was assessed independently by two authors using the Quality in Prognosis Studies (QUIPS) tool. A total of 1,822 patients from eleven studies were ultimately included. Standardized mean differences between non-survivors and survivors were compared. An elevated DNI was associated with mortality in patients with sepsis (standardized mean difference [SMD] 1.22; 95% confidence interval 0.73–1.71; I 2 = 91%). After excluding two studies—one that included paediatric patients and one with a disproportionately low mortality rate—heterogeneity was minimized (SMD 0.74, 95% confidence interval 0.53–0.94; I 2 = 43%). Overall, the findings suggest that high DNI values are associated with mortality in septic patients.

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          Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.

          Mark E Mikkelsen, Andrea N Miltiades, David F Gaieski … (2009)
          Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension). To test whether the association between initial serum lactate level and mortality in patients presenting to the emergency department (ED) with severe sepsis is independent of organ dysfunction and shock. Single-center cohort study. The primary outcome was 28-day mortality and the risk factor variable was initial venous lactate (mmol/L), categorized as low ( or = 4). Potential covariates included age, sex, race, acute and chronic organ dysfunction, severity of illness, and initiation of early goal-directed therapy. Multivariable logistic regression analyses were stratified on the presence or absence of shock. The ED of an academic tertiary care center from 2005 to 2007. Eight hundred thirty adults admitted with severe sepsis in the ED. None. Mortality at 28 days was 22.9% and median serum lactate was 2.9 mmol/L. Intermediate (odds ratio [OR] = 2.05, p = 0.024) and high serum lactate levels (OR = 4.87, p < 0.001) were associated with mortality in the nonshock subgroup. In the shock subgroup, intermediate (OR = 3.27, p = 0.022) and high serum lactate levels (OR = 4.87, p = 0.001) were also associated with mortality. After adjusting for potential confounders, intermediate and high serum lactate levels remained significantly associated with mortality within shock and nonshock strata. Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.
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            Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests.

            Thanos Athanasiou, Hannah M Jones (2004)
            The number of studies in the literature using summary receiver operating characteristic (SROC) analysis of diagnostic accuracy is rising. The SROC is useful in many such meta-analyses, but is often poorly understood by clinicians, and its use can be inappropriate. The academic literature on this topic is not always easy to comprehend. Interpretation is therefore difficult. This report aims to explain the concept of SROC analysis, its advantages, disadvantages, indications, and interpretation for the cardiothoracic surgeon. We use a practical approach to show how SROC analysis can be applied to meta-analysis of diagnostic accuracy by using a contrived dataset of studies on virtual bronchoscopy in the diagnosis of airway lesions.
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              Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study.

              Angel Arenzana, , Joan Sirvent … (2009)
              Several Surviving Sepsis Campaign Guidelines recommendations are reevaluated. To analyze the effectiveness of treatments recommended in the sepsis guidelines. In a prospective observational study, we studied all adult patients with severe sepsis from 77 intensive care units. We recorded compliance with four therapeutic goals (central venous pressure 8 mm Hg or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, central venous oxygen saturation 70% or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, blood glucose greater than or equal to the lower limit of normal but less than 150 mg/dl, and inspiratory plateau pressure less than 30 cm H(2)O for mechanically ventilated patients) and four treatments (early broad-spectrum antibiotics, fluid challenge in the event of hypotension and/or lactate greater than 36 mg/dl, low-dose steroids for septic shock, drotrecogin alfa [activated] for multiorgan failure). The primary outcome measure was hospital mortality. The effectiveness of each treatment was estimated using propensity scores. Of 2,796 patients, 41.6% died before hospital discharge. Treatments associated with lower hospital mortality were early broad-spectrum antibiotic treatment (treatment within 1 hour vs. no treatment within first 6 hours of diagnosis; odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P = 0.008) and drotrecogin alfa (activated) (odds ratio, 0.59; 95% confidence interval, 0.41-0.84; P = 0.004). Fluid challenge and low-dose steroids showed no benefits. In severe sepsis, early administration of broad-spectrum antibiotics in all patients and administration of drotrecogin alfa (activated) in the most severe patients reduce mortality.
              Article 0 comments Cited 123 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tae Ho Lim:
                ORCID: http://orcid.org/0000-0003-1045-413X
                erthim@gmail.com
                Journal
                Journal ID (nlm-ta): Sci Rep
                Journal ID (iso-abbrev): Sci Rep
                Title: Scientific Reports
                Publisher: Nature Publishing Group UK (London )
                ISSN (Electronic): 2045-2322
                Publication date (Electronic): 26 April 2018
                Publication date PMC-release: 26 April 2018
                Publication date Collection: 2018
                Volume: 8
                Electronic Location Identifier: 6621
                Affiliations
                [1 ]Department of Emergency Medicine, Armed Forces Yangju Hospital, Yangju, Korea
                [2 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Biomedical Engineering, , Graduate School of Medicine, Hanyang University, ; Seoul, Korea
                [3 ]ISNI 0000 0004 0470 5964, GRID grid.256753.0, Department of Emergency Medicine, , College of Medicine, Hallym University, ; Chuncheon, Korea
                [4 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Emergency Medicine, , College of Medicine, Hanyang University, ; Seoul, Korea
                [5 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Neurosurgery, , College of Medicine, Hanyang University, ; Seoul, Korea
                [6 ]ISNI 0000 0001 2171 7818, GRID grid.289247.2, Department of Preventive Medicine, , College of Korean Medicine, Kyung Hee University, ; Seoul, Korea
                Author information
                http://orcid.org/0000-0002-1813-1098
                http://orcid.org/0000-0002-7055-2500
                http://orcid.org/0000-0003-1045-413X
                http://orcid.org/0000-0002-7648-924X
                Article
                Publisher ID: 24211
                DOI: 10.1038/s41598-018-24211-7
                PMC ID: 5919925
                PubMed ID: 29700315
                SO-VID: 2e2a03b6-c84f-4e3b-9bf6-53931afe6678
                Copyright © © The Author(s) 2018
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 30 November 2017
                Date accepted : 23 March 2018
                Categories
                Subject: Article
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                issue-copyright-statement © The Author(s) 2018

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