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Original Article
Delta Neutrophil Index as an Early Marker for Distinguishing Myeloid from Childhood Acute Leukemia
Clin Pediatr Hematol Oncol 2018;25:128-35.
Published online October 31, 2018
© 2018 Korean Society of Pediatric Hematology-Oncology and Korean Society for Pediatric Neuro-Oncology

Joon Pyo Hong, M.D.1, Sohyun Kim, M.D.1, Byuh Ree Kim, M.D.1, Seo Hee Yoon, M.D.2, Seung Min Hahn, M.D.3 and Moon Kyu Kim, M.D.2

1Department of Pediatrics, Yonsei University College of Medicine, Divisions of 2Pediatric Emergency Medicine and
3Pediatric Hematology and Oncology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
Correspondence to: Moon Kyu Kim
Division of Pediatric Emergency Medicine, Department of Pediatrics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2067
Fax: +82-2-393-9118
Received September 18, 2018; Revised September 28, 2018; Accepted October 6, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The accurate and early diagnosis of acute myeloid leukemia (AML) is important to choose proper treatment option depending on the risk stratification. The delta neutrophil index (DNI) is a relatively new blood marker that indicates the proportion of immature granulocytes in peripheral blood circulation. This study aimed to evaluate the diagnostic value of the DNI for detecting AML in the early phase of acute leukemia.
Methods: We retrospectively analyzed laboratory tests and bone marrow study results of 163 pediatric patients with acute leukemia admitted to the emergency department, who were diagnosed with acute leukemia. An automatic analyzer (ADVIA 2120 Hematology System; Siemens Healthcare Diagnostics, Forchheim, Germany) was used to measure the DNI in the peripheral blood of each patient.
Results: The mean DNI was significantly different between the AML (N=39) and non-AML (N=124) groups (P<0.05), and the DNI was the only significant marker for predicting AML in patients with acute leukemia (odds ratio, 1.328; P<0.05). The DNI more than 4.4% has the highest predictability for distinguishing the patients with AML from the patients with acute leukemia. The mean DNI of the acute promyelocytic leukemia (APL, N=8) group was statistically higher than that of the non-APL group (N=31, P=0.019), but the DNI was not significant in the univariate logistic regression analysis.
Conclusion: The DNI might be a promising peripheral blood marker for predicting AML in the early work-up of patients with acute leukemia.
Keywords: Leukemia, Child, Acute myeloid leukemia

October 2018, 25 (2)
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  • Moon Kyu Kim