Delta neutrophil index in obese and non-obese polycystic ovary syndrome patients

OBJECTIVE

We aimed to evaluate the usefulness of delta neutrophil index (DNI), a new inflammatory marker, in polycystic ovary syndrome (PCOS).

METHODS

This retrospective case-control study was conducted at a tertiary health center. The DNI and other blood parameters obtained from the complete blood count examination of 227 individuals, consisting of 72 PCOS patients and 155 controls, were compared between the two groups. A receiver operating characteristic analysis was performed to examine the relationship between DNI and PCOS.

RESULTS

DNI, white blood cell (WBC) count, and neutrophil count were significantly higher in the PCOS group than in the control group (P=0.028, 0.011, and 0.037; respectively). DNI and WBC counts were significantly higher in nonobese-PCOS patients (P=0.018 and 0.041; respectively). When the obese-PCOS and obese-control groups were compared, only neutrophil count was significantly higher in obese-PCOS patients (P=0.016). Significance was observed at cut-off values of 0.015 (area under the curve [AUC]=0.588) (P=0.034; sensitivity, 78%; specificity, 35%; Youden's index=0.133) for DNI: 9.35 (AUC=0.594) (P=0.022) for WBC; and 5.38 (AUC=0.628) (P=0.002) for neutrophils.

CONCLUSION

Higher DNI in PCOS patients and similar results in the non-obese-PCOS group were observed when obese and non-obese-PCOS patients were considered separately. However, the lack of difference in the obese-PCOS group strengthens the hypothesis that there is obesity-independent inflammation in PCOS.

Delta Neutrophil Index as a New Early Mortality Predictor after Liver Transplantation

Background: Patients with liver disease display numerous defects of the immune system, so infection is a frequent complication of both acute and chronic liver disease. These infections are independently associated with poor outcomes after liver transplantation. Our objective was to evaluate the delta neutrophil index (DNI), a new inflammation marker, as a predictor of survival after liver transplantation (LT). Methods: This observational study retrospectively evaluated the records of 712 patients who underwent LT from January 2010 to February 2018. DNI was evaluated at pre-transplantation and 1, 7, 14, and 30 days after operation. Statistical analysis was performed using the T-test or chi-square test, and logistic regression analysis. Results: The mean MELD score was 16.7 ± 9.4 (0–48). There were 125 mortality cases (17.8%) after liver transplantation. Mean DNI was 1.61 at pre-transplantation, 3.94 one day after operation, 2.67 seven days after operation, 1.61 fourteen days after operation, and 1.64 thirty days after operation, respectively. In multivariate analysis, DNI seven and fourteen days after operation was revealed as an independent prognostic factor for mortality after liver transplantation (p = 0.040 and p < 0.0001). Conclusions: The DNI is a simple and reliable predictor of patient mortality after liver transplantation.

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

AIM

Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients.

MATERIAL AND METHOD

This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded.

RESULTS

There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05).

CONCLUSION

This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.

Increased serum delta neutrophil index levels are associated with intrahepatic cholestasis of pregnancy

OBJECTIVE

This study aims to compare the maternal serum delta neutrophil index (DNI) levels in intrahepatic cholestasis of pregnancy (ICP) and healthy pregnancies.

METHODS

This study consisted of a group of patients (n = 40) diagnosed with isolated ICP who gave birth in our hospital and a control group (n = 60) between December 1, 2015, and June 30, 2018. The diagnosis of ICP was made based on pruritus and elevated fasting serum bile acids and liver enzymes. Laboratory tests of both groups in the hospitalization process were retrospectively examined. Maternal and neonatal characteristics, pregnancy outcomes, and DNI values of the two groups were compared. Statistical analyses were performed using SPSS version 20.

RESULTS

Mean maternal serum DNI levels were significantly higher in women with ICP than in the control group (0.49 ± 4.8 vs -3.99 ± 3.02, p = <0.01). Receiver operating characteristic (ROC) curve analysis was used to define the DNI value where ICP can be best predicted.

CONCLUSION

DNI, a new inflammatory marker, was found to be higher in women with ICP than in normal pregnancies.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders

OBJECTIVE

We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa.

METHODS

The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements).

RESULTS

Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

Nicotine Alleviates Cortical Neuronal Injury by Suppressing Neuroinflammation and Upregulating Neuronal PI3K-AKT Signaling in an Eclampsia-Like Seizure Model

Our previous studies showed that treatment with alpha7 nicotinic acetylcholine receptor (α7nAChR) agonist nicotine could alleviate systemic inflammation and reduce neuronal loss in the hippocampus and seizure severity in eclampsia. In this study, we further investigated whether there is also neuronal damage in the cortex after eclamptic seizure, elucidated the potential mechanisms underlying the neuroprotective roles of nicotine in eclampsia. Retrospective analysis of MRI data of severe preeclampsia (SPE) patients was conducted. A preeclampsia model was established by lipopolysaccharide injection (PE group), and pentylenetetrazol was used to induce eclamptic seizure (E group). α7nAChR agonist nicotine and its antagonist (α-BGT) and PI3K inhibitor wortmannin were used for drug administration. Neuronal damage was detected by Nissl staining, and changes in neuroinflammation, neuronal apoptosis, α7nAChR expression, and PI3K-AKT signaling on cortical neurons were detected by immunohistochemistry and western blotting. MRI images showed that most abnormal signals from the brain of SPE patients were located in the cortex. The neuron survival ratio was lower in the cortex than in the hippocampus within the E group; such ratios in the cortex were significantly lower in the E and PE groups compared with those of the control group. Nicotine markedly decreased the production of inflammatory cytokines and microglial activation in the cortex of the E group. Moreover, nicotine increased p-AKT levels and decreased cleaved caspase-3 levels in cortical neurons. Treatment with α-BGT reversed effects of nicotine. Wortmannin also blocked the anti-neuronal apoptosis action of nicotine. Our results suggest that nicotine protects against neuronal injury in the cortex following eclampsia possibly by inhibiting neuroinflammation and activating neuronal PI3K-AKT pathway.

Is the serum delta neutrophil index level different in gestational diabetic women?

Objective: To investigate the serum delta neutrophil index (DNI) levels between normal pregnant women and gestational diabetic women.Methods: Normal pregnant women and gestational diabetic women delivered in the University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital between 1 December 2015 and 30 June 2018 were included in the study. The study group included patients diagnosed with gestational diabetes by a 100-g or 75-g OGTT (n = 273). The control group included women with singleton pregnancies who had normal antenatal follow-up and who had delivered healthy neonates after 37 gestational weeks (n = 455). In both the study and control groups, for the analysis of DNI and other laboratory values, the ones reported at the time of the application for delivery or within previous 4 weeks of delivery were used. The study and control groups were compared with each other with respect to the DNI value (primary outcome measure of the study), maternal and newborn characteristics, pregnancy outcomes and laboratory values other than DNI (secondary outcome measures). Statistical analyses were performed using SPSS for Windows, version 22.0. The Student t-test, the Mann-Whitney U-test, and the χ² test were used where appropriate. A p value of <.05 was considered statistically significant.Results: There were significant differences between the study and control groups regarding median maternal age, gravidity, parity, BMI and gestational age at delivery (p < .05). Mean birthweight was significantly higher in the study group compared to control group (p=.002). NICU admission was significantly more frequent in the study group than in the control group (8.8% vs 2.4%; p < .001). The platelet, WBC, neutrophil and monocyte counts and NLRs were significantly lower, while Hb and DNI values were significantly higher in the study group than in the control group. The median DNI values were -2.30 (range: -27.0 to 8.10) and -3.0(range: -27.30 to 11.60) in the study and control groups, respectively (p = .007).Conclusion: The DNI, a new inflammatory marker, was found to be higher in gestational diabetic women, than in those with normal pregnancies.

Increased Delta Neutrophil Index Is Associated With Poor Prognosis in Cadaver Donor Kidney Transplantation

OBJECTIVE

Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocyte in acute infection, has been reported as a useful, predictable marker for mortality in patients with sepsis. We have hypothesized that an increased recipient DNI is associated with poor prognosis in cadaver donor kidney transplantation.

METHODS

We investigated patients undergoing kidney transplantation from cadaver donors from March 2013 to January 2018. Rejection was diagnosed by kidney biopsy with Banff classification and excluded subclinical rejection.

RESULTS

In a total of 73 patients undergoing cadaver kidney transplantation, 25 (34.2%) patients were diagnosed with rejection based on the Banff classification. Among them, 11 patients were diagnosed with early rejection. The recipients' postoperative DNI (%) was different between patients with early rejection and patients without rejection (0.18 vs 1.21, P < .001). In the univariate logistic regression analysis, cold ischemic time, donor preoperative last creatinine level, postoperative DNI level, and perioperative infection were predictive of early rejection. However, in a multivariate adjusted logistic regression test, only a high level of DNI (odds ratio 12.307, 95% confidence interval [CI] 1.22-129.82) was associated with early rejection. The C-statistic was 0.777 (95% CI 0.604-0.951, P = .004) for DNI. In multivariate Cox regression analysis, the donor's last creatinine level (hazard ratio 2.25, 95% CI 1.26-4.13) and preoperative DNI (hazard ratio 14.02 95% CI 2.62-75.26) were predictors of renal survival.

CONCLUSIONS

Increased DNI in cadaver donor kidney transplantation recipients might be one of the predictive values of early kidney rejection and prognosis.