The role of delta neutrophil index as a novel biomarker in the management of mechanical intestinal obstruction

Objective : Intestinal obstructions are an important health problem for emergency surgery, accounting for approximately 15% of admissions to the emergency department due to abdominal pain and approximately 20% of emergency surgical interventions for abdominal pain. It is important for the clinician to make an accurate and timely decision during the diagnosis, follow-up and treatment process of the patients, especially because of the increased risk of mortality and morbidity with the development of intestinal ischemia. However, laboratory and imaging tests, which are widely used in emergency conditions, are insufficient to distinguish intestinal ischemia and necrosis. Delta neutrophil index (DNI) has recently emerged as a promising biomarker in the diagnosis and follow-up processes of infective and inflammatory diseases. The aim of this study is to investigate in which steps and how successfully DNI can help the clinician in the treatment of mechanical bowel obstruction. Methods: Demographic, epidemiological, laboratory and clinical data of 1027 patients who were admitted to Ankara Yıldırım Beyazıt University Faculty of Medicine Ankara City Hospital General Surgery Clinic between 01 April 2019 and 01 April 2021 with the diagnosis of mechanical bowel obstruction were retrospectively analyzed. 78 patients fulfillin exclusion criteria were excluded. The data of the remaining 949 patients, according to the origin of the pathology; were considered as extrinsic, intraluminal and transmural groups. The data of the remaining 949 patients, according to the origin of the pathology; were considered as extrinsic, intraluminal and transmural groups. Because the physiopathology and clinical process were similar, the data of the patients with intraluminal and transmural etiology were analyzed in the 'intrinsic group'. Results: The duration of admission to the emergency department was found to be significantly higher in those who underwent intestinal resection and those who developed mortality. (p=0.021, p=<0.001). The duration of conservative treatment was found to be significantly higher in patients with intestinal ischemia and in patients who underwent resection. (p=0.001, p=<0.001). Mortality development was found to be significantly higher in patients with intestinal ischemia, intestinal resection and ostomy procedure. (p<0.001). After conservative treatment, preoperative DNI changes were found to be significantly increased in patients who underwent surgery, intestinal ischemia, and intestinal resection. (p<0.001). DNI cut-off values that can be used in mechanical intestinal obstruction with extrinsic etiology are 0.45% (preoperative), 0.45% (preoperative), 1.15% (preoperative), 2.45% (postoperative 2nd day) in predicting intestinal ischemia, resection, intensive care need and mortality, respectively. The sensitivity / specificity of these values were respectively; 68.9% / 62.4%, 78.9% / 65%, 67.4% / 61.7%, 79.4% / 80.7% and all of them had p values <0.001. In the intrinsik group, DNI values ​​were almost completely impractical. Conclusion : In patients with mechanical intestinal obstruction, 24 hours may be the critical period for the development of intestinal ischemia, resection and mortality during the conservative treatment. When evaluating patients, DNI values of ≥2% and increases of ≥1 unit during follow-up may be warning for the clinician. As a result of our study, we think that DNI can be used by clinicians in the management of mechanical bowel obstruction with its cost-effective, fast, highly efficient and statistically high success. Keywords : Mechanical intestinal obstruction, Delta Neutrophil Index, DNI