Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department.

Luisa Agnello,Anna Maria Ciaccio,Silvia Mancuso,Matteo Vidali,Salvatore Maestri,Alessandro Iacona,Marcello Ciaccio,Rosaria Vincenza Giglio,Bruna Lo Sasso

doi:10.3390/diagnostics11071292

Abstract

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6–32.9) and SI (median 1.15, IQR 1.05–1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

Highlights

Among all the biomarkers investigated, the parameters belonging to the Complete Blood Count (CBC) have emerged as precious tools providing a wealth of information on individual health statuses
We found that the monocyte distribution width (MDW) had high sensitivity and specificity for sepsis screening both in the Emergency Department (ED) and in intensive care unit (ICU) [12,13,14]
We validated the performance of the Sepsis Index for the screening of patients at a high risk of developing sepsis in the ED

Summary

Introduction

Sepsis is a highly complex disease caused by a deregulated host response to infection It has been recently recognised as a global health priority by the World Health Organization due to its high mortality and morbidity [1]. The Food and Drug Administration approved the MDW, known as the Early Sepsis Indicator (ESId), as a biomarker for the identification of patients with sepsis or at risk of developing sepsis in the Emergency Department (ED). It represents a morphometric indicator of monocyte size variability similar to the red blood cell distribution width. We found that the MDW had high sensitivity and specificity for sepsis screening both in the ED and in ICU [12,13,14]

Objectives

Methods

Results

Conclusion