Delta neutrophil index as an indicator after preperitoneal pelvic packing in hemodynamically unstable pelvic fracture patients in Korea: a retrospective cohort study

Purpose: Although several studies of preperitoneal pelvic packing (PPP) have reported a hemostatic effect in patients with pelvic fractures, the presence of packed surgical tapes may provoke inflammation or infection. In Korean institutions, the delta neutrophil index (DNI) is currently used as a clinical biomarker for identifying sepsis and predicting prognosis. Therefore, this study aimed to evaluate the usefulness of DNI in pelvic fracture patients who underwent PPP.Methods: We retrospectively reviewed 36 hemodynamically unstable patients who underwent PPP between May 2014 and December 2018 at Wonju Severance Christian Hospital. To evaluate differences in postoperative DNI patterns between survivors and nonsurvivors, repeated-measures analysis of variance was performed.Results: Eight patients died, and 16 patients developed PPP-related complications. Packed surgical tapes were maintained for a mean of 46.3 hours. Compared with survivors, nonsurvivors had significantly higher DNI values on postoperative day (POD) 2 (5.3% [range, 0%–40.2%] vs. 36.0% [range, 5.4%–70.2%], P<0.001) and POD 3 (2.6% [range, 0%–16.3%] vs. 29.9% [range, 1.2%–64.2%], P<0.001). The overall pattern of DNI change over time differed significantly between survivors and nonsurvivors (P=0.001). In addition, patients with PPP-related complications exhibited a significantly smaller decrease in DNI between POD 1 and POD 2 compared with those without complications (–1.6% [range, −7.8% to 58.9%] vs. –4.5% [−46.8% to 31.6%], P=0.048).Conclusion: Postoperative DNI may serve as a clinical indicator for predicting mortality and complications in pelvic fracture patients who have undergone PPP.