Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department : comparison with CRP and procalcitonin in a multicenter international European prospective study
Hausfater, Pierre (UMR INSERM 1166, IHU ICAN, Sorbonne Université)
Robert Boter, Neus (Universitat Autònoma de Barcelona. Departament de Medicina)
Morales Indiano, Cristian (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cancella de Abreu, Marta (Sorbonne Université, GRC-14 BIOSFAST)
Mendoza Marin, Adria (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pernet, Julie (APHP-Sorbonne Université. Emergency Department, Hôpital Pitié-Salpêtrière)
Quesada, Dolores (Universitat Autònoma de Barcelona. Departament de Genètica i de Microbiologia)
Castro, Iris (Beckman Coulter, Inc)
Careaga, Diana (Beckman Coulter, Inc)
Arock, Michel (APHP-Sorbonne Université. Biochemisty and Emergency Biology Department, Hôpital Pitié-Salpêtrière)
Tejidor, Liliana (Beckman Coulter, Inc)
Velly, Laetitia (Sorbonne Université, GRC-14 BIOSFAST)

Date:	2021
Abstract:	Early 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). Subjects 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). A 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]. MDW 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Monocyte volume distribution width ; MDW ; Procalcitonin ; C-reactive protein ; Emergency department ; Sepsis
Published in:	Critical Care, Vol. 25 (june 2021) , ISSN 1466-609X

DOI: 10.1186/s13054-021-03622-5
PMID: 34193208

12 p, 1.6 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles