Delta Neutrophil Index (DNI) and Prognosis in a Male Patient with Alcohol Ketoacidosis (AKA)

Patient selection: male with alcoholic ketoacidosis (AKA)

The delta neutrophil index (DNI) is a measure of the immature granulocyte fraction reported by some hematology analyzers.

DNI =

= ((neutrophil subfraction) + (eosinophil subfraction)) - (PMN subfraction)

where:

• The neutrophil and eosinophil subfractions are measured in the myeloperoxidase channel.

• The PMN subfraction is measured in the nuclear lobularity channel by reflected light beam.

Predictors of worse survival in multivariate analysis:

(1) initial DNI >= 4.75%

(2) initial lower arterial pH < 7.1

The same parameters are also predictive of reduced renal survival.

Items from univariate analysis associated with worse prognosis:

(1) cardiac arrest

(2) need for inotropes

(3) rhabdomyolysis

(4) mechanical ventilation

(5) prolonged PT or INR