Levin Scott, Sarani Nima, Hinson Jeremiah, Naiman Melissa, Cannon Chad, Smith Aria, Steinhart Benjamin, DeBraine Arnaud, Kehoe Sarah, Immhoff Bryan, Taribichi Yasir, Malinovska Alexandra, Badaki-Makun Kemi
Beckman Coulter, Brea, CA.
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Crit Care Explor. 2025 Jan 10;7(1):e1194. doi: 10.1097/CCE.0000000000001194. eCollection 2025 Jan 1.
Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.
A retrospective observational study.
The ED of the University of Kansas Medical Center, United States.
All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.
MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.
In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.
The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.
利用全血细胞计数（CBC）及分类计数（CBC-diff）进行早期脓毒症检测，对急诊科护理具有实用价值，尤其是对于那些没有明显症状的患者。本研究的目的是开发一种包含单核细胞分布宽度（MDW）的CBC脓毒症指数（CBC-SI），以加强脓毒症的快速筛查。
一项回顾性观察研究。
美国堪萨斯大学医学中心急诊科。
2020年8月8日至2022年4月1日期间到急诊科就诊、接受CBC-diff作为常规临床护理一部分的所有成年患者（年龄18岁及以上）。
使用MDW、白细胞计数和中性粒细胞与淋巴细胞比值来开发用于早期脓毒症检测的CBC-SI（0为低风险至5为高风险）。评估了CBC-SI对有和没有明显早期脓毒症迹象患者的诊断性能。
在51407次急诊科就诊的队列中，1683例（3.3%）符合脓毒症标准；1343例（79.8%）脓毒症患者有明显症状，340例（20.2%）没有明显症状。CBC-SI的曲线下总面积为0.83（95%CI，0.81-0.85）。CBC-SI大于或等于1分表现出83.1%（95%CI，79.9-86.2%）的敏感性和64.8%（95%CI，64.0-65.5%）的特异性。在没有明显症状的患者亚组中观察到了更好的性能；大于或等于1分，敏感性为81.1%（95%CI，73.2-88.9%），特异性为69.1%（95%CI，68.3-69.9%）。与有明显症状的脓毒症亚组相比，没有明显症状的脓毒症患者从就诊到使用抗生素的时间延迟（中位数4.7小时对3.4小时；p<0.001），入住重症监护病房的比例更高（43.8%对27.9%；p<0.001），院内死亡率也更高（14.7%对9.8%；p=0.011）。
CBC-SI在早期脓毒症检测中表现出强大性能。其性能在无明显症状的表现中最佳，表明在最易受干预延迟和预后较差影响的亚组中效用最高。
