Malinovska Alexandra, Hinson Jeremiah S, Badaki-Makun Oluwakemi, Hernried Benjamin, Smith Aria, Debraine Arnaud, Toerper Matthew, Rothman Richard E, Kickler Thomas, Levin Scott
Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA.
Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore Maryland USA.
J Am Coll Emerg Physicians Open. 2022 Feb 28;3(2):e12679. doi: 10.1002/emp2.12679. eCollection 2022 Apr.
Enhancement of a routine complete blood count (CBC) for detection of sepsis in the emergency department (ED) has pragmatic utility for early management. This study evaluated the performance of monocyte distribution width (MDW) alone and in combination with other routine CBC parameters as a screen for sepsis and septic shock in ED patients.
A prospective cohort analysis of adult patients with a CBC collected at an urban ED from January 2020 through July 2021. The performance of MDW, white blood count (WBC) count, and neutrophil-to-lymphocyte-ratio (NLR) to detect sepsis and septic shock (Sepsis-3 Criteria) was evaluated using diagnostic performance measures.
The cohort included 7952 ED patients, with 180 meeting criteria for sepsis; 43 with septic shock and 137 without shock. MDW was highest for patients with septic shock (median 24.8 U, interquartile range [IQR] 22.0-28.1) and trended downward for patients with sepsis without shock (23.9 U, IQR 20.2-26.8), infection (20.4 U, IQR 18.2-23.3), then controls (18.6 U, IQR 17.1-20.4). In isolation, MDW detected sepsis and septic shock with an area under the receiver operator characteristic curve (AUC) of 0.80 (95% confidence interval [CI] 0.77-0.84) and 0.85 (95% CI 0.80-0 .91), respectively. Optimal performance was achieved in combination with WBC count and NLR for detection of sepsis (AUC 0.86, 95% CI 0.83-0.89) and septic shock (0.86, 95% CI 0.80-0.92).
A CBC differential panel that includes MDW demonstrated strong performance characteristics in a broad ED population suggesting pragmatic value as a rapid screen for sepsis and septic shock.
改进急诊科（ED）用于检测脓毒症的常规全血细胞计数（CBC），对早期管理具有实用价值。本研究评估了单核细胞分布宽度（MDW）单独以及与其他常规CBC参数联合作为ED患者脓毒症和脓毒性休克筛查指标的性能。
对2020年1月至2021年7月在城市急诊科进行CBC检查的成年患者进行前瞻性队列分析。使用诊断性能指标评估MDW、白细胞计数（WBC）和中性粒细胞与淋巴细胞比值（NLR）检测脓毒症和脓毒性休克（脓毒症-3标准）的性能。
该队列包括7952例ED患者，其中180例符合脓毒症标准；43例为脓毒性休克，137例无休克。脓毒性休克患者的MDW最高（中位数24.8 U，四分位间距[IQR]22.0-28.1），无休克的脓毒症患者（23.9 U，IQR 20.2-26.8）、感染患者（20.4 U，IQR 18.2-23.3），然后是对照组（18.6 U，IQR 17.1-20.4）呈下降趋势。单独使用时，MDW检测脓毒症和脓毒性休克的受试者工作特征曲线下面积（AUC）分别为0.80（95%置信区间[CI]0.77-0.84）和0.85（95%CI 0.80-0.91）。与WBC计数和NLR联合检测脓毒症（AUC 0.86，95%CI 0.83-0.89）和脓毒性休克（0.86，95%CI 0.80-0.92）时达到最佳性能。
包含MDW的CBC差异检测组合在广泛的ED人群中表现出强大的性能特征，表明其作为脓毒症和脓毒性休克快速筛查指标具有实用价值。
