Improved Early Detection of Sepsis in the Emergency Department with a Novel Monocyte Distribution Width Biomarker

Background

Sepsis most often presents to the emergency department (ED), and delayed detection is harmful. The white blood count (WBC) is often used to detect sepsis, but changes in WBC size also correspond with sepsis. We sought to determine if volume increases of circulating immune cells adds value to the WBC for early sepsis detection in the ED.

Methods

A blinded, prospective cohort study was conducted in two different ED populations within a large academic hospital.

Results

Neutrophil and monocyte volume parameters were measured in conjunction with routine CBC testing on a UniCel® DxH 800 analyzer at the time of ED admission and were evaluated for the detection of sepsis. 1320 ED subjects were consecutively enrolled and categorized as controls (n=879), systemic inflammatory response syndrome (SIRS) (n=203), infection (n=140), or sepsis (n=98). Compared to other parameters, monocyte distribution width (MDW) best discriminated sepsis from all other conditions [AUC 0.79 (95% CI: 0.73-0.84)]; sensitivity 0.77, specificity 0.73; MDW threshold of 20.50.], sepsis from SIRS [AUC 0.74 (95% CI: 0.67-0.84)] and severe sepsis from non-infected ED patients [AUC 0.88 (95% CI: 0.75-0.99); NPV 99%]. The added value of MDW to WBC was statistically significant (AUC 0.89 for MDW + WBC vs 0.81 for WBC alone; p Conclusions

http://ift.tt/2rVsNfQ