Abstract
Abstract Background Sepsis is the main cause of death in patients with acquired immunodeficiency syndrome (AIDS) and early diagnosis of sepsis in AIDS remains a significant challenge. Monocyte distribution width (MDW), as a new type of sepsis auxiliary diagnostic marker, has attracted widespread attention in the research and exploration of its clinical application. This study aims to evaluate the diagnostic efficacy of MDW in the occurrence of sepsis in HIV-infected patients and to construct a new clinical diagnostic model in combination MDW with other indicators. Methods A prospective cohort study was conducted at Shanghai Public Health Center with a total of 602 patients enrolled between December 2022 and August 2023. Sepsis-3 criteria were employed as the diagnostic standard for sepsis. MDW was measured at admission, using the hematology analyzer DxH900 (Beckman Coulter Inc.). Comprehensive clinical data, including complete blood counts and biochemical profiles, were collected. Enrolled participants received a follow-up about their survivals on day 30 and day 90. Five machine learning models were evaluated and compared to select the best performing model. Results The diagnostic performance of MDW for sepsis yielded an AUC of 0.818. With a cut-off value of 25.26, the sensitivity and specificity reached 0.822 and 0.754 respectively. The best performing variable among all five ML algorithms was Random Forest model. The top three variables with the highest importance ranking were platelet, albumin, and hemoglobin. Incorporating MDW and the top three laboratory indicators into a random forest model, the AUC value improved to 0.931. With a cut-off value of 0.5, the sensitivity was 1.00 while the specificity was 0.732. Conclusions MDW was an auxiliary diagnostic biomarker for sepsis in HIV-infected patients with reliable sensitivity and specificity. In combination MDW with other common laboratory biomarkers, a diagnostic model can be established to further improve the diagnostic efficiency of sepsis.
Published Version
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