{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:38:27Z","timestamp":1770817107595,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kangdong Sacred Heart Hospital Fund","award":["2022-08"],"award-info":[{"award-number":["2022-08"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The delta neutrophil index (DNI) represents the immature granulocyte fraction and is determined by subtracting the fraction of mature polymorphonuclear leucocytes from the sum of myeloperoxidase-reactive cells. The DNI has been proposed as a useful prognostic marker for sepsis. This study evaluated the clinical utility of DNI as a predictive marker in patients with pneumonia-induced sepsis in the intensive care unit (ICU). Methods: We conducted a retrospective study of pneumonia-induced sepsis in patients who were admitted to the Kangdong Sacred Heart Hospital\u2019s medical ICUs from July 2022 to March 2024. The DNI was measured on three consecutive days after ICU admission. The primary outcome of this study was a 28-day mortality. Results: A total of 227 patients with pneumonia-induced sepsis were included in this study. A 28-day mortality occurred 20.3% of the time in our study. In a univariate analysis, age (p = 0.05), lymphocyte (p = 0.02), DNI 1 (p = 0.01), DNI 2 (p = 0.00), DNI 3 (p = 0.00), and lactic acid (p = 0.00) were significantly associated with 28-day mortality. In a multivariable analysis, lactate (adj. OR: 0.86, 95% CI: 0.78\u20130.95, p = 0.002), and DNI 3 (adj. OR: 0.94, 95% CI: 0.89\u20130.99, p = 0.048) were significantly associated with 28-day mortality. In our study, the most appropriate cut-off values were DNI 1 (7.15), DNI 2 (8.9), and DNI 3 (2.6). Patients with higher DNI 3 (\u22652.6) showed higher 28-day mortality than patients with lower DNI 3 values of &lt;2.6 (67.4% vs. 32.6%; p &lt; 0.001). However, those aged \u226570 did not show statistically significantly different DNI 1 values between the survivor and non- survivor groups. Conclusions: The DNI at 72 h after ICU admission is a promising predictive prognostic marker of 28-day mortality in patients with pneumonia-induced sepsis in the ICU. However, the interpretation of the DNI in sepsis patients aged 70 and older on the first day of hospitalization should be approached with caution.<\/jats:p>","DOI":"10.3390\/jcm14062002","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T04:29:28Z","timestamp":1742185768000},"page":"2002","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Usefulness of Delta Neutrophil Index (DNI) for Prediction of 28 Day Mortality in Patients with Pneumonia-Induced Sepsis in the Intensive Care Unit"],"prefix":"10.3390","volume":"14","author":[{"given":"SooYoon","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Nephrology, Korea University Guro Hospital, Division of Pulmonary, Allergy and Critical Care Medicine, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YongBum","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7745-9205","authenticated-orcid":false,"given":"Chang-Won","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Physiology, Kyungpook National University, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunghoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Seoul 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3746-4947","authenticated-orcid":false,"given":"YunSu","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1703-6590","authenticated-orcid":false,"given":"Yousang","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-2462","authenticated-orcid":false,"given":"SoYoung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1378\/chest.07-1456","article-title":"A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU","volume":"133","author":"Restrepo","year":"2008","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1111\/j.1532-5415.2012.04208.x","article-title":"Clinical and economic burden of community-acquired pneumonia in the Medicare fee-for-service population","volume":"60","author":"Yu","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_3","first-page":"1299","article-title":"Diagnosis and management of community-acquired pneumonia in adults","volume":"83","author":"Watkins","year":"2011","journal-title":"Am. Fam. Physician"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1378\/chest.08-0334","article-title":"Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia","volume":"134","author":"Aliberti","year":"2008","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"213970","DOI":"10.1111\/ijcp.13970","article-title":"Efficacy of the delta neutrophil index in predicting 30-day mortality in COVID-19 patients requiring intensive care","volume":"75","author":"Birben","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.jinf.2011.08.004","article-title":"New concepts in the pathogenesis, diagnosis and treatment of bacteremia and sepsis","volume":"63","author":"Huttunen","year":"2011","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ahn, C., Kim, W., Lim, T.H., Cho, Y., Choi, K.S., and Jang, B.H. (2018). The delta neutrophil index (DNI) as a prognostic marker for mortality in adults with sepsis: A systematic review and meta-analysis. Sci. Rep., 26.","DOI":"10.1038\/s41598-018-24211-7"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13054-015-0778-z","article-title":"The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation","volume":"19","author":"Mare","year":"2015","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1177\/0885066610377980","article-title":"Review of A Large Clinical Series: Is the Band Count Useful in the Diagnosis of Infection?","volume":"25","author":"Cavallazzi","year":"2010","journal-title":"J. Intensive Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S0272-2712(03)00069-6","article-title":"Clinical utility of the band count","volume":"22","author":"Cornbleet","year":"2002","journal-title":"Clin. Lab. Med."},{"key":"ref_11","first-page":"241","article-title":"Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis","volume":"38","author":"Nahm","year":"2008","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/SHK.0b013e3182454acf","article-title":"Delta neutrophil index: A promising diagnostic and prognostic marker for sepsis","volume":"37","author":"Seok","year":"2012","journal-title":"Shock"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Park, B.H., Kang, Y.A., Park, M.S., Jung, W.J., Lee, S.H., Lee, S.K., Kim, S.Y., Kim, S.K., Chang, J., and Jung, J.Y. (2011). Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis. BMC Infect. Dis., 11.","DOI":"10.1186\/1471-2334-11-299"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"647","DOI":"10.3343\/alm.2015.35.6.647","article-title":"Use of delta neutrophil index for differentiating low-grade community-acquired pneumonia from upper respiratory infection","volume":"35","author":"Kim","year":"2015","journal-title":"Ann. Lab. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/SHK.0000000000000936","article-title":"A Simplified Mortality Score Using Delta Neutrophil Index and the Thrombotic Microangiopathy Score for Prognostication in Critically Ill Patients","volume":"49","author":"Goag","year":"2018","journal-title":"Shock"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/SHK.0000000000000722","article-title":"Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments","volume":"47","author":"Kim","year":"2017","journal-title":"Shock"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/j.ajem.2015.06.012","article-title":"Newly designed delta neutrophil index-to-serum albumin ratio prognosis of early mortality in severe sepsis","volume":"33","author":"Hwang","year":"2015","journal-title":"Am. J. Emerg. Med."},{"key":"ref_18","first-page":"5","article-title":"Community-acquired pneumonia: Identification and evaluation of nonresponders","volume":"1","author":"Conceicao","year":"2013","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"94","DOI":"10.3947\/ic.2014.46.2.94","article-title":"Delta neutrophil index as a prognostic marker of early mortality in gram negative bacteremia","volume":"46","author":"Kim","year":"2014","journal-title":"Infect. Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lee, T., Lee, J., Shin, D.H., Lee, H., and Kim, S.K. (2023). Prognostic and Diagnostic Power of Delta Neutrophil Index and Mean Platelet Component in Febrile Patients with Suspected Sepsis. Biomedicines, 11.","DOI":"10.20944\/preprints202311.0135.v1"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Shin, J.E., Deok Seo, K., Cha, H.J., Lee, J.W., Heo, Y.M., Kim, K.K., Kim, T.G., Kang, C., Lee, G.S., and Song, J.H. (2022). Usefulness of the delta neutrophil index in predicting surgery in patients with foot and ankle infection. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0272574"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1177\/0885066620933245","article-title":"A Modified Simple Scoring System Using the Red Blood Cell Distribution Width, Delta Neutrophil Index, and Mean Platelet Volume-to-Platelet Count to Predict 28-Day Mortality in Patients With Sepsis","volume":"36","author":"Kim","year":"2021","journal-title":"J. Intensive Care Med."},{"key":"ref_24","first-page":"e14748","article-title":"Predictive Efficacy of Delta Neutrophil Index in Diagnosis of Acute and Complicated Appendicitis","volume":"13","author":"Birben","year":"2021","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Park, S.Y., Lee, J.S., Oh, J., and Park, J.Y. (2020). Delta neutrophil index as a predictive and prognostic factor for Candidemia patients: A matched case-control study. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05117-0"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e22895","DOI":"10.1002\/jcla.22895","article-title":"Delta neutrophil index as a prognostic marker in emergent abdominal surgery","volume":"33","author":"Soh","year":"2019","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1097\/SHK.0000000000001299","article-title":"Delta neutrophil index for the prediction of the development of sepsis-induced acute kidney injury in the emergency department","volume":"52","author":"Kim","year":"2019","journal-title":"Shock"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S1473-3099(13)70001-X","article-title":"Immunosuppression in sepsis: A novel understanding of the disorder and a new therapeutic approach","volume":"13","author":"Hotchkiss","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4161\/viru.25436","article-title":"Host innate immune responses to sepsis","volume":"5","author":"Wiersinga","year":"2014","journal-title":"Virulence"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/SHK.0b013e3181e7e61b","article-title":"Neutrophil paralysis in sepsis","volume":"34","author":"Spiller","year":"2010","journal-title":"Shock"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1111\/apa.12052","article-title":"Usefulness of the delta neutrophil index for assessing neonatal sepsis","volume":"102","author":"Lee","year":"2013","journal-title":"Acta Paediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"605347","DOI":"10.3389\/fpsyt.2020.605347","article-title":"Aging as a Context for the Role of Inflammation in Depressive Symptoms","volume":"11","author":"Straka","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"89791","DOI":"10.5492\/wjccm.v14.i2.98791","article-title":"Why should lymphocytes immune profile matter in sepsis?","volume":"14","author":"Nedel","year":"2025","journal-title":"World J. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"589","DOI":"10.37349\/ei.2022.00070","article-title":"Rao Understanding sepsis-induced immunosuppression and organ dysfunctions: From immunosuppression to immunotherapy","volume":"2","author":"Gupta","year":"2022","journal-title":"Explor. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13054-024-05099-4","article-title":"Lymphopenia in sepsis: A narrative review","volume":"28","author":"Wang","year":"2024","journal-title":"Crit. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2002\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:54:22Z","timestamp":1760028862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,15]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14062002"],"URL":"https:\/\/doi.org\/10.3390\/jcm14062002","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,15]]}}}