Top

Published in:

Open Access 01-12-2021 | Septicemia | Research

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

Authors: Pierre Hausfater, Neus Robert Boter, Cristian Morales Indiano, Marta Cancella de Abreu, Adria Mendoza Marin, Julie Pernet, Dolores Quesada, Iris Castro, Diana Careaga, Michel Arock, Liliana Tejidor, Laetitia Velly

Published in: Critical Care | Issue 1/2021

Abstract

Background

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).

Methods

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).

Results

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].

Conclusions

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.

Trial Registration ClinicalTrials.gov (NCT03588325).

Available only for authorised users

Page DB, Donnelly JP, Wang HE. Community-, healthcare-, and hospital-acquired severe sepsis hospitalizations in the university healthsystem consortium. Crit Care Med. 2015;43(9):1945–51. https://doi.org/10.1097/CCM.0000000000001164.CrossRefPubMedPubMedCentral

EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intens Care Med. 2004;30(4):580–588. https://doi.org/10.1007/s00134-003-2121-4

Leisman DE. Sepsis presenting in hospitals versus emergency departments: demographic, resuscitation, and outcome patterns in a multicenter retrospective cohort. J Hospital Med. 2019. https://doi.org/10.12788/jhm.3188.CrossRef

Anand V, Zhang Z, Kadri SS, Klompas M, Rhee C. Epidemiology of quick sequential organ failure assessment criteria in undifferentiated patients and association with suspected infection and sepsis. Chest. 2019;156(2):289–97. https://doi.org/10.1016/j.chest.2019.03.032.CrossRefPubMedPubMedCentral

Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77. https://doi.org/10.1007/s00134-017-4683-6.CrossRef

Kalil AC, Machado FR. Quick sequential organ failure assessment is not good for ruling sepsis in or out. Chest. 2019;156(2):197–9. https://doi.org/10.1016/j.chest.2019.06.003.CrossRefPubMed

Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent J-L. Biomarkers of sepsis: time for a reappraisal. Crit Care. 2020. https://doi.org/10.1186/s13054-020-02993-5.CrossRefPubMedPubMedCentral

Crouser ED, Parrillo JE, Seymour C, et al. Improved early detection of sepsis in the ED with a novel monocyte distribution width biomarker. Chest. 2017;152(3):518–26. https://doi.org/10.1016/j.chest.2017.05.039.CrossRefPubMedPubMedCentral

Crouser ED, Parrillo JE, Seymour CW, et al. Monocyte distribution width: a novel indicator of sepsis-2 and sepsis-3 in high-risk emergency department patients. Crit Care Med. 2019;47(8):1018–25. https://doi.org/10.1097/CCM.0000000000003799.CrossRefPubMedPubMedCentral

10.

Crouser ED, Parrillo JE, Martin GS, et al. Monocyte distribution width enhances early sepsis detection in the emergency department beyond SIRS and qSOFA. J Intens Care. 2020. https://doi.org/10.1186/s40560-020-00446-3.CrossRef

11.

Polilli E, Sozio F, Frattari A, et al. Comparison of monocyte distribution width (MDW) and procalcitonin for early recognition of sepsis. Kou YR ed. PLoS ONE. 2020;15(1):e0227300. https://doi.org/10.1371/journal.pone.0227300.CrossRefPubMedPubMedCentral

12.

Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31(4):1250–6. https://doi.org/10.1097/01.CCM.0000050454.01978.3B.CrossRefPubMed

13.

Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):762. https://doi.org/10.1001/jama.2016.0288.CrossRefPubMedPubMedCentral

14.

The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure 4.

15.

Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intens Care Med. 2003;29(4):530–8. https://doi.org/10.1007/s00134-003-1662-x.CrossRef

16.

Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):775. https://doi.org/10.1001/jama.2016.0289.CrossRefPubMedPubMedCentral

17.

Herrendörfer G, Johnson NL, Kotz S, Kemp AW. Univariate discrete distributions. 2nd ed. Wiley; 1992.

18.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.CrossRef

19.

McGee S. Simplifying likelihood ratios. J Gen Intern Med. 2002;17(8):646–9. https://doi.org/10.1046/j.1525-1497.2002.10750.x.CrossRefPubMed

20.

Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ. 2004;329(7458):168–9. https://doi.org/10.1136/bmj.329.7458.168.CrossRefPubMedPubMedCentral

21.

Vincent J-L, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016. https://doi.org/10.1186/s13054-016-1389-z.CrossRefPubMedPubMedCentral

22.

Hwang SY, Jo IJ, Lee SU, et al. Low accuracy of positive qSOFA criteria for predicting 28-day mortality in critically ill septic patients during the early period after emergency department presentation. Ann Emerg Med. 2018;71(1):1-9.e2. https://doi.org/10.1016/j.annemergmed.2017.05.022.CrossRefPubMed

23.

Ljungström L, Pernestig A-K, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. Azevedo LCP ed. PLoS ONE. 2017;12(7):e0181704. https://doi.org/10.1371/journal.pone.0181704.CrossRefPubMedPubMedCentral

24.

Uusitalo-Seppälä R, Koskinen P, Leino A, Peuravuori H, Vahlberg T, Rintala EM. Early detection of severe sepsis in the emergency room: diagnostic value of plasma C-reactive protein, procalcitonin, and interleukin-6. Scand J Infect Dis. 2011;43(11–12):883–90. https://doi.org/10.3109/00365548.2011.600325.CrossRefPubMed

25.

Claessens Y-E, Mathevon T, Kierzek G, et al. Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia. Intensive Care Med. 2010;36(5):799–809. https://doi.org/10.1007/s00134-010-1818-4.CrossRefPubMed

26.

Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B. Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care. 2007;11(3):R60. https://doi.org/10.1186/cc5926.CrossRefPubMedPubMedCentral

27.

Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis. 2002;34(7):895–901. https://doi.org/10.1086/339198.CrossRefPubMed

28.

Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis in the United States. Crit Care Med. 2017;45(9):1443–9. https://doi.org/10.1097/CCM.0000000000002538.CrossRefPubMedPubMedCentral

29.

Long B, April MD. Are qSOFA criteria better than the systemic inflammatory response syndrome criteria for diagnosing sepsis and predicting inhospital mortality? Ann Emerg Med. 2018;72(4):470–2. https://doi.org/10.1016/j.annemergmed.2018.03.008.CrossRefPubMed

30.

Henning DJ, Puskarich MA, Self WH, et al. An emergency department validation of the SEP-3 sepsis and septic shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017;70(4):544-552.e5. https://doi.org/10.1016/j.annemergmed.2017.01.008.CrossRefPubMedPubMedCentral

Title: 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
Authors: Pierre Hausfater
Neus Robert Boter
Cristian Morales Indiano
Marta Cancella de Abreu
Adria Mendoza Marin
Julie Pernet
Dolores Quesada
Iris Castro
Diana Careaga
Michel Arock
Liliana Tejidor
Laetitia Velly
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Septicemia
Septicemia
Published in: Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-021-03622-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Comparison of renal histopathology and gene expression profiles between severe COVID-19 and bacterial sepsis in critically ill patients

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

Letter to the editor in response to "Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis"

A hypolipoprotein sepsis phenotype indicates reduced lipoprotein antioxidant capacity, increased endothelial dysfunction and organ failure, and worse clinical outcomes

Factors influencing local signs at catheter insertion site regardless of catheter-related bloodstream infections

Burden of pneumococcal pneumonia requiring ICU admission in France: 1-year prognosis, resources use, and costs