The usefulness of serum biomarker C-reactive protein, delta neutrophil index, lactic acid and ammonia for differential diagnosis in patients with drowsy mentality in emergency department

Kang, HyunKoo; Jeong, Rubi; Kim, YoungSik; Lee, KyooHyun; Yu, WooSung; Yoon, YoungTak; Kim, Hak Jung

J Korean Soc Emerg Med > Volume 33(4); 2022 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2022;33(4): 355-362.

기면 상태의 의식 저하로 응급의료센터에 내원한 비외상 환자들에서 뇌졸중이 아닌 원인 질환 감별을 위한 혈중 C-reactive protein, delta neutrophil index, lactic acid 및 ammonia 측정의 유용성

강현구

분당제생병원 응급의학과

The usefulness of serum biomarker C-reactive protein, delta neutrophil index, lactic acid and ammonia for differential diagnosis in patients with drowsy mentality in emergency department

Department of Emergency Medicine, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea

Correspondence

HyunKoo Kang ,Tel: 031-779-0183, Fax: 031-779-6528, Email: jalsaluh84@naver.com,

Received: August 12, 2021; Revised: September 15, 2021 Accepted: October 14, 2021. Published online: August 31, 2022.

ABSTRACT

Objective:
A drowsy mentality is a common chief complaint at emergency departments (EDs), but it is difficult to evaluate the reason for drowsy mentality. Serum biomarkers are an alternative way to discover the reason for drowsy mentalities. This study examined the values of four biomarkers for a differential diagnosis of ED patients with drowsy mentality: Creactive protein (CRP), delta neutrophil index (DNI), lactic acid and ammonia.
Method:
Adult patients who presented to the ED from April 2018 to March 2019 were reviewed retrospectively. Among the 369 patients with a drowsy mentality, 122 patients with acute trauma, dementia, epilepsy, seizure, alcohol abuse, syncope, psychological problems, and anaphylaxis were excluded. The four biomarkers of each patient were then measured. The clinical records were reviewed to analyze the usefulness of the four biomarkers as a differential diagnosis tool for ED patients.
Results:
Of the 247 included patients, 64 were diagnosed with a stroke, and 183 were not. CRP, DNI, lactic acid and ammonia were analyzed statistically, and the elevation of each biomarker level was related to a diagnosis of non-stroke disease.
Conclusion:
Elevations of CRP, DNI, lactic acid and ammonia suggest non-stroke disease in patients with drowsy mentality in ED. There might be metabolic causes other than stroke in ED patients with a drowsy mentality when the CRP, DNI, lactic acid and ammonia levels are highly elevated. A future study will be needed to confirm this.

Key words: C-reactive protein; Delta neutrophil index; Ammonia; Lactic acid; Stroke