Monocyte distribution width compared with C-reactive protein and procalcitonin for early sepsis detection in the emergency department.

A La Woo,Dong Kyu Oh,Sang-Bum Hong,Chan-Jeoung Park,Aleksandar R Zivkovic

doi:10.1371/journal.pone.0250101

A La Woo, Dong Kyu Oh + Show 3 more

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https://doi.org/10.1371/journal.pone.0250101

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Journal: PloS one	Publication Date: Apr 15, 2021
Citations: 31	License type: CC BY 4.0

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

PurposeMonocyte distribution width (MDW) has been suggested as an early biomarker of sepsis, but few studies have compared MDW with conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT). This study evaluated MDW as a biomarker for sepsis and compared it with CRP and PCT.Materials and methodsPatients aged 18–80 years who visited the emergency department were screened and prospectively enrolled in a tertiary medical center. Complete blood count, MDW, CRP, and PCT were examined. Diagnostic performance for sepsis was tested using the area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity.ResultsIn total, 665 patients were screened, and 549 patients with valid laboratory test results were included in the analysis. The patients were categorized into three groups according to the Sepsis-3 criteria: non-infection, infection, and sepsis. MDW showed the highest value in the sepsis group (median [interquartile range], 24.0 [20.8–27.8]). The AUC values for MDW, CRP, PCT, and white blood cells for predicting sepsis were 0.71 (95% confidence interval [CI], 0.67–0.75), 0.75 (95% CI, 0.71–0.78], 0.76 (95% CI, 0.72–0.79, and 0.61 (95% CI, 0.57–0.65), respectively. With the optimal cutoff value of the cohort, the sensitivity was 83.0% for MDW (cutoff, 19.8), 69.7% for CRP (cutoff, 4.0), and 76.6% for PCT (cutoff, 0.05). The combination of quick Sequential Organ Failure Assessment (qSOFA) with MDW improved the AUC (0.76; 95% CI, 0.72–0.80) to a greater extent than qSOFA alone (0.67; 95% CI, 0.62–0.72).ConclusionsMDW reflected a diagnostic performance comparable to that of conventional diagnostic markers, implying that MDW is an alternative biomarker. The combination of MDW and qSOFA improves the diagnostic performance for early sepsis.

Highlights

Sepsis is a common reason for patients to visit the emergency department (ED), hospital admission, and intensive care unit (ICU) mortality [1]
The area under the curve (AUC) values for Monocyte distribution width (MDW), C-reactive protein (CRP), PCT, and white blood cells for predicting sepsis were 0.71 (95% confidence interval [CI], 0.67–0.75), 0.75
The combination of quick Sequential Organ Failure Assessment with MDW improved the AUC (0.76; 95% CI, 0.72–0.80) to a greater extent than quick SOFA (qSOFA) alone (0.67; 95% CI, 0.62–0.72)

Summary

Introduction

Sepsis is a common reason for patients to visit the emergency department (ED), hospital admission, and intensive care unit (ICU) mortality [1]. As the early administration of antibiotics results in better clinical outcomes [2,3,4], earlier detection helps in developing better sepsis management strategies. The detection of sepsis is often delayed because of the complexity of the Sequential Organ Failure Assessment (SOFA). To overcome the complexity of the SOFA, the Sepsis-3 group [5] has suggested using the quick SOFA (qSOFA) for rapid assessment. Using biomarkers in sepsis detection may be beneficial in decision making for further evaluation of sepsis. No biomarkers have been recommended in the current sepsis guidelines

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