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Delta neutrophil index가 응급센터를 통하여 중환자실로 입원한 환자들의 원내 사망률을 예측할 수 있는가?

Does delta neutrophil index predict 30-day mortality in patients admitted to intensive care unit via emergency department?

대한응급의학회지 2020년 31권 2호 p.152 ~ 160
윤영탁 ( Yoon Young-Tak ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine

김영식 ( Kim Young-Sik ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
하영록 ( Ha Young-Rock ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
신태용 ( Shin Tae-Yong ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
 ( Jung Ru-Bi ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
 ( Lee Kyoo-Hyun ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
유우성 ( Yu Woo-Sung ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine
김동훈 ( Kim Dong-Hoon ) - Bundang Jesaeng General Hospital Daejin Medical Center Department of Emergency Medicine

Abstract


Objective: A retrospective study was performed to evaluate the usefulness of the delta neutrophil index as a prognostic factor for mortality in intensive care unit patients admitted via the emergency department.

Method: Patients, who presented to the emergency department and were admitted to the intensive care unit from January 2018 to August 2018, were reviewed retrospectively. The clinical features, inflammatory marker levels, such as C-reactive protein, lactate, simplified acute physiology score 3, length of stay, and in-hospital mortality were obtained from the medical records. Patients, who visited the emergency department because of trauma or suicidal attempts, arrived after out-hospital cardiac arrest, or were diagnosed with cerebrovascular disease, were excluded.

Results: Of the 310 patients included, 65 died during their admission, and 245 patients were discharged after treatment. The receiver operating characteristic curve showed that the delta neutrophil index (area under curve [AUC], 0.72), Creactive protein (AUC, 0.70), lactate (AUC, 0.64), and simplified acute physiology score 3 (AUC, 0.79) indicated a low predictive power for in-hospital mortality. Whole patients were divided into four subgroups (infectious diseases, cardiovascular diseases, gastrointestinal bleeding diseases, and others). The receiver operating curve of delta neutrophil index revealed infectious diseases (AUC, 0.65), in cardiovascular diseases (AUC, 0.70), and gastrointestinal bleeding diseases (AUC, 0.79).

Conclusion: The role of the delta neutrophil index for predicting the prognosis of in-hospital mortality showed equally low predictive power for critically ill patients with the C-reactive protein and lactate.

키워드

Delta neutrophil index; Mortality rate; Emergency department; Intensive care unit
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