Abstract
BackgroundEarly sepsis diagnosis has emerged as one of the main challenges in the emergency room. Measurement of sepsis biomarkers is largely used in current practice to improve the diagnosis accuracy. Monocyte distribution width (MDW) is a recent new sepsis biomarker, available as part of the complete blood count with differential. The objective was to evaluate the performance of MDW for the detection of sepsis in the emergency department (ED) and to compare to procalcitonin (PCT) and C-reactive protein (CRP).MethodsSubjects whose initial evaluation included a complete blood count were enrolled consecutively in 2 EDs in France and Spain and categorized per Sepsis-2 and Sepsis-3 criteria. The performance of MDW for sepsis detection was compared to that of procalcitonin (PCT) and C-reactive protein (CRP).ResultsA total of 1,517 patients were analyzed: 837 men and 680 women, mean age 61 ± 19 years, 260 (17.1%) categorized as Sepsis-2 and 144 patients (9.5%) as Sepsis-3. The AUCs [95% confidence interval] for the diagnosis of Sepsis-2 were 0.81 [0.78–0.84] and 0.86 [0.84–0.88] for MDW and MDW combined with WBC, respectively. For Sepsis-3, MDW performance was 0.82 [0.79–0.85]. The performance of MDW combined with WBC for Sepsis-2 in a subgroup of patients with low sepsis pretest probability was 0.90 [0.84–0.95]. The AUC for sepsis detection using MDW combined with WBC was similar to CRP alone (0.85 [0.83–0.87]) and exceeded that of PCT. Combining the biomarkers did not improve the AUC. Compared to normal MDW, abnormal MDW increased the odds of Sepsis-2 by factor of 5.5 [4.2–7.1, 95% CI] and Sepsis-3 by 7.6 [5.1–11.3, 95% CI].ConclusionsMDW in combination with WBC has the diagnostic accuracy to detect sepsis, particularly when assessed in patients with lower pretest sepsis probability. We suggest the use of MDW as a systematic screening test, used together with qSOFA score to improve the accuracy of sepsis diagnosis in the emergency department.Trial Registration ClinicalTrials.gov (NCT03588325).
Highlights
A significant proportion of patients developing sepsis enter the health system through an emergency department (ED) [1,2,3,4]
Treating physicians were blinded to Monocyte distribution width (MDW), PCT and C-reactive protein (CRP) values obtained by protocol, but received PCT and/or CRP results they ordered as current practice
The diagnostic ability of MDW combined with white blood cells (WBC) was similar to CRP alone (AUROC: 0.86 [0.84– 0.88] vs. 0.85 [0.83–0.87], respectively) and performed better than PCT alone (AUROC: 0.78 [0.75–0.81])
Summary
MDW, a hematologic parameter measured as part of the complete blood count with differential (CBC-DIFF) and describing the size distribution of circulating monocytes, was shown in two recent North American studies [8,9,10] to be a valuable new sepsis biomarker for the early detection of patients in the emergency department. Little is known about the performance of MDW and how it compares to those of the most frequently used sepsis biomarkers: C-reactive protein (CRP) and procalcitonin (PCT) [11]. Monocyte distribution width (MDW) is a recent new sepsis biomarker, available as part of the complete blood count with differential. The objective was to evaluate the performance of MDW for the detection of sepsis in the emergency department (ED) and to compare to procalcitonin (PCT) and C-reactive protein (CRP)
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