A new tool for sepsis screening in the Emergency Department

Agnello, Luisa; Iacona, Alessandro; Sasso, Bruna Lo; Scazzone, Concetta; Pantuso, Michele; Giglio, Rosaria Vincenza; Gambino, Caterina Maria; Ciaccio, Anna Maria; Bivona, Giulia; Vidali, Matteo; Ciaccio, Marcello

doi:10.1515/cclm-2021-0208

Cited by 24 publications

(20 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using the previously established decisional cut-off values of 23 and 1 for the MDW and SI, respectively [ 13 , 16 ], we found out that, in this validation cohort, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for sepsis were, respectively, 0.79 (MDW) vs. 0.79 (SI), 0.84 vs. 0.91, 0.27 vs. 0.38, 0.98 vs. 0.98, 5.08 vs. 8.52 and 0.25 vs. 0.23.…”

Section: Resultsmentioning

confidence: 99%

“…The MDW was measured on whole-blood venous samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser (Beckman Coulter, Inc., Brea, CA, USA) within 2 h from the collection, as recommended by the manufacturer, after the laboratory analysis ordered by the ED clinicians were completed. The SI was calculated for each patient by applying the formula based on the values of the MDW and MMV, as previously described [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Although, in our studies, the MDW showed a good diagnostic performance for sepsis screening, we observed that some individuals were not correctly classified according to its value, especially in the ED. Accordingly, we developed an index, namely the Sepsis Index (SI), to improve the specificity of the MDW [ 16 ]. SI is based on the combination of MDW with another CBC parameter related to the morphological characteristics of monocytes, the mean monocyte volume (MMV).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2021

Self Cite

View full text Add to dashboard Cite

(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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…It has been approved by the Food and Drug Administration (FDA) as a biomarker for the early detection of sepsis in ED. Recently, several authors showed that MDW has good diagnostic accuracy for early-identifying patients at high risk of developing sepsis, especially in the ED and the ICU [114][115][116][117][118][119][120][121][122][123]. MDW is characterized by a high negative predictive value for sepsis diagnosis.…”

Section: Monocyte Distribution Widthmentioning

confidence: 99%

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

et al. 2021

Self Cite

View full text Add to dashboard Cite

Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.

show abstract

“…Based on morphological changes in monocytes during inflammation, the sepsis index ((SI), based on MDW and mean monocyte volume (MMV)) significantly improves the accuracy of early sepsis screening and diagnosis. 28 , 29 A blind, prospective cohort study was conducted in two different emergency departments at Ohio State University by Crouser et al, 30 1320 subjects were enrolled in the ED consecutively. Those patients were grouped into systemic inflammatory response syndrome (SIRS), infection, and sepsis (including sepsis, severe sepsis, and septic shock) groups, and MDW was measured using a UniCel DxH 800 analyzer.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Wu¹,

Li²,

Luo³

2022

JIR

View full text Add to dashboard Cite

Monocyte distribution width (MDW) is a blood monocyte morphological parameter that can be easily detected by an automated hemocyte analyzer and can provide clinicians with important information about cell volume variability in peripheral blood monocyte populations. The United States’ Food and Drug Administration and Conformite Europeenne have both been cleared for their clinical application in the detection of sepsis and developing sepsis in adult patients in the emergency department (ED). Recently, MDW has been found to have an early diagnosis and predictive value for sepsis in neonates and COVID-19 patients. Here, we summarize the findings of the studies investigating the clinical application of MDW in sepsis. Under different stimuli, especially in infectious diseases, the activation of innate immunity is the host’s first defense mechanism, and the change in monocyte volume is considered an early indicator reflecting the state of activation of innate immunity. Pivotal study data from a large multicenter patient cohort showed that abnormal MDW at presentation increases the odds of sepsis, considering the combination of MDW and White Blood Cell Count (WBC) as part of a standard sepsis assessment protocol for ED, which may increase the sensitivity and specificity of sepsis diagnosis. Meanwhile, MDW shares a diagnostic performance comparable to that of conventional biomarkers (C-reactive protein and procalcitonin) in sepsis. In addition, some evidence suggests that increased MDW, both in adults and neonates, may be associated with unfavorable short- and long-term outcomes, which indicates its prognostic value in sepsis. Taken together, MDW is a parameter of increased morphological variability of monocytes in response to infection, and numerous studies have shown that MDW could be used as a valuable diagnostic and prognostic index in patients with sepsis or suspected sepsis.

show abstract

A new tool for sepsis screening in the Emergency Department

Cited by 24 publications

References 16 publications

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

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

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Contact Info

Product

Resources

About