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Kim S, Park JH, Lim H, Lee H, Song SW. Association of Delta Neutrophil Index with the 30-day Mortality in Adult Cardiac Surgical Patients. Int J Med Sci 2024; 21:1730-1737. [PMID: 39006852 PMCID: PMC11241090 DOI: 10.7150/ijms.97400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose: This study aimed to assess the predictive accuracy of 30-day mortality with delta neutrophil index (DNI) in adult cardiac surgical patients. Methods: This study enrolled patients who underwent cardiac surgery under general anesthesia between March 2016 and May 2022 at a tertiary hospital in the Republic of Korea. DNI was measured preoperatively, on postoperative arrival to the surgical intensive care unit (ICU), and 12, 24, 48, and 72 h postoperatively. Receiver operating characteristic (ROC) analysis was employed to identify the prediction accuracy of DNI. An area under ROC curve (AUROC) ≥0.700 was defined as satisfactory predictive accuracy. An optimal cutoff point for the DNI value to maximize predictive accuracy was revealed in the ROC curve, where [sensitivity + specificity] was maximum. Results: This study included a total of 843 patients in the final analyses. The mean age of the study population was 66.9±12.2 years and 38.4% of them were female patients. The overall 30-day mortality rate was 5.2%. Surgery involving the thoracic aorta, history of prior cardiac surgery, or emergency surgery were associated with a higher mortality rate. The DNI showed satisfactory predictive accuracy at 24 h, 48 h, and 72 h postoperatively, with AUROC of 0.729, 0.711, and 0.755, respectively. The optimal cutoff points of DNI at each time point were 3.2, 3.8, and 2.3, respectively. Conclusions: Postoperative DNI is a good predictor of 30-day mortality after cardiac surgery and has the benefit of no additional financial costs or time.
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Affiliation(s)
- Sujin Kim
- Wonju Severance Christian Hospital, Republic of Korea
| | - Ji-Hyoung Park
- Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Hyunjae Lim
- Wonju Severance Christian Hospital, Republic of Korea
| | - Haesung Lee
- Wonju Severance Christian Hospital, Republic of Korea
| | - Seung Woo Song
- Wonju College of Medicine, Yonsei University, Republic of Korea
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Chung JS, Jang SW, Jung PY, Kim MJ, Choi YU, Bae KS, Kim S. Indicative factors for surgical or angiographic intervention in hemodynamically stable patients with blunt abdominal trauma: A retrospective cohort study. J Visc Surg 2023; 160:12-18. [PMID: 35459632 DOI: 10.1016/j.jviscsurg.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The standard of care for intraperitoneal injury in hemodynamically stable patients after blunt abdominal trauma has been replaced by non-operative management (NOM). However, selective NOM, depending on the situation, seems necessary in determining the treatment plan. In this study, we attempted to identify risk factors for surgical or angiographic intervention (SAI) in hemodynamically stable blunt abdominal trauma patients. METHODS This retrospective study which included adult patients who were brought to a regional trauma center was conducted from March 2015 to October 2019. We evaluated the characteristics of blunt abdominal trauma patients and analyzed factors that were related to the requirement of SAI in these patients. Patients were divided into SAI and conservative management (CM) groups. RESULTS We reviewed 1,176 patients, and after exclusions, of whom 248 blunt abdominal trauma and free fluid observed on CT were identified. The mean pulse rate was higher in the SAI than in the CM (P=0.025). Laboratory findings showed that lactate and delta neutrophil index (DNI) levels were higher in the SAI than in the CM (P=0.002 and 0.026 respectively). Additionally, the mean free fluid size in the SAI (85.69mm) was significantly larger than that in the CM (68.12mm; P=0.001), and blush was more frequently observed in the SAI (P<0.001). In multivariate analysis, only blush was an independent prognostic factor for SAI (OR 11.7, 95% CI, 5.1-30.8, P<0.001). CONCLUSION In hemodynamically stable patients with blunt abdominal trauma, blush but also high lactate and DNI are associated with the requirement of interventional radiology and/or surgery.
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Affiliation(s)
- J S Chung
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - S W Jang
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - P Y Jung
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - M J Kim
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - Y U Choi
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - K S Bae
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - S Kim
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Ko JW, Kim MJ, Choi YU, Shim H, Chung H, Jang JY, Bae KS, Kim K. Determination of Risk Factors for Predicting Bladder-Urethra Injury in Cases of Pelvic Bone Fracture: A Retrospective Single Center Study. JOURNAL OF ACUTE CARE SURGERY 2022. [DOI: 10.17479/jacs.2022.12.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.Methods: Patients (> 18 years) with pelvic injury (<i>N</i> = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.Results: Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; <i>p</i> = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; <i>p</i> < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; <i>p</i> = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; <i>p</i> = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; <i>p</i> = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); <i>p</i> = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); <i>p</i> = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.Conclusion: Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.
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Kim K, Ha G, Jang SW, Jang JY, Bae KS. Determination of the radiologic findings for predicting failure of conservative management with observation for blunt renal injury patients: A single-centre experience over 13 years. Injury 2021; 52:2588-2593. [PMID: 34134853 DOI: 10.1016/j.injury.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Most blunt renal injuries (BRIs) are managed conservatively without complications. Because conservative management with observation (CMO) is widely conducted, failed CMO is frequent. Clarifying the role and indication of CMO is important to manage BRI patients. Therefore, this study was conducted to analyse factors related to failed CMO. METHODS BRI patients (aged >13 years) who were admitted via the emergency department in Wonju Severance Christian Hospital were analysed retrospectively between January 2008 and July 2020. Patient characteristics, including clinical data, laboratory findings, transfusion requirements, injury grade, initial CT findings, length of hospital stay, intensive care unit stay, and mortality, were investigated for all enrolled patients. RESULTS Kidney injury grade ≥ 4, perinephric haematoma rim distance (PHD), length of main laceration, intravascular contrast extravasation (ICE), Gerota's fascia discontinuity, multiple lacerations, dissociated renal fragment and complexity of laceration were statistically significantly different between the successful CMO and failed CMO groups in the comparative analysis. The multivariate analysis showed that perinephric haematoma rim distance [odds ratio (OR) 1.44 [95% confidence interval (CI) 1.09 - 1.90], p = 0.011] and ICE [OR 7.41 (95% CI 2.20 - 24.99), p = 0.001] were mutually independent risk factors associated with failed CMO. When the ROC curve of PHD and ICE was generated to predict the failure of CMO, the area under the curve (AUC) was 0.884 (95% CI, 0.826 - 0.942), p < 0.001), and the optimal cut-off value for PHD was 2.9 cm, and for ICE was presence of ICE on CT [sensitivity: 90.5% (95% CI, 0.70 - 0.99), specificity: 78.0% (95% CI, 0.73 - 0.83)]. CONCLUSION PHD and ICE may be useful factors to predict failed CMO for BRI patients. PHD > 2.9 cm and the presence of ICE may indicate who will require invasive procedures. Close observation is wise for patients with these risk factors.
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Affiliation(s)
- Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.
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Çomçalı B, Kocaoz S, Altun Özdemir B, Canlıkarakaya F, Korukluoğlu B. What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women? Eur J Obstet Gynecol Reprod Biol 2021; 264:219-223. [PMID: 34375821 DOI: 10.1016/j.ejogrb.2021.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. PATIENTS AND METHODS Herein, 1542 patients, aged 18-49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. RESULTS In the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). CONCLUSION The Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women.
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Affiliation(s)
- Bülent Çomçalı
- Department of General Surgery, Ankara City Hospital, Çankaya, Ankara, Turkey.
| | - Servet Kocaoz
- Department of General Surgery, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Buket Altun Özdemir
- Department of General Surgery, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Fırat Canlıkarakaya
- Department of General Surgery, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Birol Korukluoğlu
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Çankaya, Ankara, Turkey
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Choi EJ, Choi S, Kang BH. Indications for Laparotomy in Patients with Abdominal Penetrating Injuries Presenting with Ambiguous Computed Tomography Findings. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ha G, Jang SW, Shin IS, Bang HJ, An S, Bae KS, Jang JY, Kim YW, Kim K. Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years. Ann Surg Treat Res 2021; 101:49-57. [PMID: 34235116 PMCID: PMC8255582 DOI: 10.4174/astr.2021.101.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. Methods The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. Results Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. Conclusion When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota's fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.
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Affiliation(s)
- Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - In Sik Shin
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Hui-Jae Bang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
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Narcı H, Berkeşoğlu M, Üçbilek E, Ayrık C. The usefulness of the percentage of immature granulocytes in predicting in-hospital mortality in patients with upper gastrointestinal bleeding. Am J Emerg Med 2020; 46:646-650. [PMID: 33358899 DOI: 10.1016/j.ajem.2020.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is an important health problem with a potentially life threatening course. Measurement of immature granulocytes percentage (IG %), reflecting the fraction of circulating immature granulocyte (IG), is associated with increased mortality in patients with systemic inflammation, or distress. The aim of this study was to evaluate whether the IG% is an effective predictive marker for estimating the in-hospital mortality for patients with UGIB admitting to the emergency department (ED). METHOD This retrospective study included patients with UGIB who admitted to the ED, between 01.01.2019 and 31.12.2019. The patients were divided into two groups as discharged and dead. The IG% and other parameters were recorded. The primary end point of the study was in-hospital mortality. Logistic regression model was used to determine the factors affecting mortality. RESULTS This study included 149 patients, 94 of whom were men. The mean age of the patients was 64.5 ± 14.2. Twenty patients died during hospitalization and 129 were discharged. IG% was significantly higher in patients who died compared with patients who discharged. In the receiver operating characteristic (ROC) curves analysis to determine the in-hospital mortality, the cut-off value (>1%) for IG% level was found specificity (93.8%), sensitivity (100%), positive predictive value (PPV = 71.43%), negative predictive value (NPV = 100.00%) and area under curve (AUC = 0.98). Univariate logistic regression analysis showed that IG% was predicting in-hospital mortality (odds ratio, OR = 65.6, confidence interval, CI = 2.00-2152.6). CONCLUSıONS: High IG% levels may be used as a predictor of in-hospital mortality in patients with UGIB.
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Affiliation(s)
- Hüseyin Narcı
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey.
| | - Mustafa Berkeşoğlu
- Mersin University, Faculty of Medicine, Department of General Surgery, Mersin, Turkey
| | - Enver Üçbilek
- Associate professor, Mersin University, Faculty of Medicine, Department of Gastroenterology, Mersin, Turkey
| | - Cüneyt Ayrık
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
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