Abstract
In this study, we developed and evaluated the diagnostic accuracy of the Sepsis Index for early sepsis screening in the Emergency Department (ED). Sepsis Index is based on the combination of monocyte distribution width (MDW) and mean monocyte volume (MMV). Sepsis Index≥1 was selected to define sepsis. We tested its diagnostic accuracy in an ED population stratified in four groups: controls, Systemic Inflammatory Response Syndrome (SIRS), infection, and sepsis, according to Sepsis-2 criteria. Patients with sepsis displayed higher median Sepsis Index value than patients without sepsis. At the receiver operating characterictis (ROC) curve analysis forthe prediction of sepsis, the area under the curve (AUC) of MDW and Sepsis Index were similar: 0.966 (95%CI 0.947-0.984), and 0.964 (95%CI 0.942-0.985), respectively. Sepsis Index showed increased specificity than MDW (94.7vs. 90.6%), without any decrease in sensitivity (92.0%). Additionally, LR+ increased from 9.8 (MDW) to 17.4(Sepsis Index), without any substantial change in LR- (respectively 0.09 vs. 0.08). Finally, PPV increased from 0.286 (MDW) to 0.420 (Sepsis Index). Sepsis Index improves the diagnostic accuracy of MDW alone for sepsis screening.
Highlights
Sepsis represents a significant global health problem associated with a high rate of mortality [1,2]
We found that patients with the same monocyte distribution width (MDW), but belonging to different subgroups, showed different mean monocyte volume (MMV), a research parameter cell population data
Applying the Sepsis Index (≥1) to the incorrectly classified patients based on MDW ranging 23–26 we found that 50 out 77 controls, 24 out 61 with infection and 15 out 24 with Systemic Inflammatory Response Syndrome (SIRS) were correctly reclassified as being without sepsis
Summary
Sepsis represents a significant global health problem associated with a high rate of mortality [1,2]. It is defined as a life-threatening organ dysfunction due to a deregulated host response to infection. The rapid detection of infection is crucial in order to prevent the development of sepsis. This is challenging and the sepsis recognition is often delayed. Useful biomarkers for identifying patients at risk of developing sepsis are strongly sought after. Among all molecules investigated [3,4,5,6], the role of monocyte distribution width (MDW) has recently emerged [7,8,9,10,11,12,13]
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