Yonker Lael M, Badaki-Makun Oluwakemi, Alvarez-Carcamo Bryan, Cross Cody, Okuducu Yanki, Appleman Lori, Greatorex Jaime, Onu Rosemary E, Santos Christine, Petherbridge Rachel, Foy Brody H, Careaga Diana, Naiman Melissa, Castro Iris, Haller Logan, Guthrie Lauren B, Higgins John M, Lewandrowski Kent B, Irimia Daniel
Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Shock. 2025 Mar 1;63(3):385-389. doi: 10.1097/SHK.0000000000002502. Epub 2024 Oct 11.
Background: Early, accurate determination of disease severity in an emergency setting is paramount for improving patient outcomes and healthcare costs. Monocyte anisocytosis, quantified as monocyte distribution width (MDW), has been shown to correspond with immune dysregulation. We hypothesize that MDW is broadly associated with illness severity related to sepsis and serious infection in children. Methods: We designed a retrospective study to analyze MDW, as measured by UniCel DxH 900 analyzer, on whole blood samples that were collected from children presenting for medical care between April 2020 and September 2022. SIRS criteria and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated, and source of infection was documented. Outcomes were compared by t test or ANOVA, and receiver operating characteristic (ROC) curves assessed accuracy of MDW in identifying sepsis in children. Results: We analyzed samples from 394 children presenting with illness to two pediatric medical centers. MDW was significantly higher in children with sepsis (28.2 ± 7.8) than children with suspected or confirmed infection who did not display signs of sepsis (21.5 ± 5.2). An ROC curve comparing MDW of children with sepsis against infected children without sepsis displayed an area under the curve of 0.78, suggesting MDW may serve as a useful tool in identifying children with sepsis. Discussion: When children present to the urgent care/emergency setting with signs of infection, MDW may serve as a prompt tool to aid clinicians in identifying those who are at high risk for severe illness and require closer monitoring/intervention compared to those who may be safely discharged home.
在急诊环境中早期、准确地确定疾病严重程度对于改善患者预后和医疗成本至关重要。单核细胞异质性，以单核细胞分布宽度（MDW）量化，已被证明与免疫失调相关。我们假设MDW与儿童脓毒症和严重感染相关的疾病严重程度广泛相关。方法：我们设计了一项回顾性研究，以分析通过UniCel DxH 900分析仪测量的全血样本中的MDW，这些样本采集自2020年4月至2022年9月前来就医的儿童。计算全身炎症反应综合征（SIRS）标准和儿童序贯器官衰竭评估（pSOFA）评分，并记录感染源。通过t检验或方差分析比较结果，并使用受试者工作特征（ROC）曲线评估MDW在识别儿童脓毒症中的准确性。结果：我们分析了来自两个儿科医疗中心的394名患病儿童的样本。脓毒症患儿的MDW（28.2±7.8）显著高于未表现出脓毒症迹象的疑似或确诊感染患儿（21.5±5.2）。比较脓毒症患儿与未患脓毒症的感染患儿MDW的ROC曲线显示曲线下面积为0.78，表明MDW可能是识别脓毒症患儿的有用工具。讨论：当儿童在紧急护理/急诊环境中出现感染迹象时，MDW可能作为一种快速工具，帮助临床医生识别那些与可能安全出院回家的儿童相比有严重疾病高风险且需要密切监测/干预的儿童。
