DELTA NEUTROPHIL INDEX AS PROGNOSTIC MARKER OF MORTALITY IN ADULTS WITH SEPSIS

Abstract

Background: Sepsis remains a leading cause of global mortality, demanding accurate and timely prognostic tools to guide clinical decision-making. The Delta-Neutrophil Index (DNI), an automated measure of circulating immature granulocytes, has emerged as a potential biomarker for assessing disease severity and predicting mortality in critically ill adults.

Objective: This review critically evaluates the prognostic value of DNI in adult sepsis, comparing it with established biomarkers and clinical scoring systems, and exploring its potential integration into sepsis management strategies.

Methods: A thorough search of the literature using Web of Science, PubMed, and Scopus was done to identify observational, cohort, interventional, and meta-analytic studies published up to 2025 that assessed DNI in adult sepsis populations. Key outcomes included mortality prediction, optimal cutoff values, and correlation with severity scores.

Results: Across multiple studies, elevated DNI was consistently associated with higher mortality risk, independent of traditional severity scores. Optimal cutoffs ranged between 5% and 8%, with reported AUC values generally exceeding 0.75. Serial measurements improved prognostic accuracy, and combining DNI with other biomarkers or scoring systems enhanced predictive performance.

Conclusion: DNI is a promising, accessible biomarker for mortality risk assessment in adult sepsis, offering unique cellular-level insights. However, variability in cutoffs, study designs, and patient populations necessitates large-scale, multicenter prospective validation before routine clinical adoption.