Abstract
(1) Background: Sepsis is a life-threatening condition, and most patients with sepsis first present to the emergency department (ED) where early identification of sepsis is challenging due to the unavailability of an effective diagnostic model. (2) Methods: In this retrospective study, patients aged ≥20 years who presented to the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were included. The SIRS, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) scores were obtained for all patients. Routine complete blood cell testing in conjugation with the examination of new inflammatory biomarkers, namely monocyte distribution width (MDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), was performed at the ED. Propensity score matching was performed between patients with and without sepsis. Logistic regression was used for constructing models for early sepsis prediction. (3) Results: We included 296 patients with sepsis and 1184 without sepsis. A SIRS score of >2, a SOFA score of >2, and a qSOFA score of >1 showed low sensitivity, moderate specificity, and limited diagnostic accuracy for predicting early sepsis infection (c-statistics of 0.660, 0.576, and 0.536, respectively). MDW > 20, PLR > 9, and PLR > 210 showed higher sensitivity and moderate specificity. When we combined these biomarkers and scoring systems, we observed a significant improvement in diagnostic performance (c-statistics of 0.796 for a SIRS score of >2, 0.761 for a SOFA score of >2, and 0.757 for a qSOFA score of >1); (4) Conclusions: The new biomarkers MDW, NLR, and PLR can be used for the early detection of sepsis in the current sepsis scoring systems.
Highlights
Sepsis, a life-threatening condition, is substantially associated with high morbidity and mortality in health care systems worldwide [1,2,3,4,5,6]
monocyte distribution width (MDW) > 20, platelet-to-lymphocyte ratio (PLR) > 9, and PLR > 210 showed higher sensitivity and moderate specificity. When we combined these biomarkers and scoring systems, we observed a significant improvement in diagnostic performance (c-statistics of 0.796 for a systemic inflammatory response syndrome (SIRS) score of >2, 0.761 for a sequential organ failure assessment (SOFA) score of >2, and 0.757 for a quick SOFA (qSOFA) score of >1); (4) Conclusions: The new biomarkers MDW, neutrophil-to-lymphocyte ratio (NLR), and PLR can be used for the early detection of sepsis in the current sepsis scoring systems
The recommended approach to sepsis is based on two definitions: (1) as per Sepsis-2 criteria published in 1992, sepsis is defined as documented infection in conjugation with a systemic inflammatory response syndrome (SIRS) score of ≥2 points [11]; and (2) as per Sepsis-3 criteria published in 2016, sepsis is defined as a quick sequential organ failure assessment score of ≥2 [12] followed by an acute change of ≥2 points in the SOFA score [13] due to the infection [14]
Summary
A life-threatening condition, is substantially associated with high morbidity and mortality in health care systems worldwide [1,2,3,4,5,6]. Physicians in the emergency department (ED) who first encounter a patient in health settings should detect any sign of sepsis progression [10]. Numerous biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT), have been used for the early detection of sepsis [9,15,16,17]. CRP is widely available, the turnaround time (TAT) for CRP is longer than a routine CBC report (including MDW). Emergency physicians may order these tests based on the results of routine complete blood cell count (CBC) analysis performed using a hematology analyzer. If a point-of-care testing of CRP was not available, this may cause a delay of early antibiotic use
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