scholarly journals Monocyte distribution width compared with C-reactive protein and procalcitonin for early sepsis detection in the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250101
Author(s):  
A la Woo ◽  
Dong Kyu Oh ◽  
Chan-Jeoung Park ◽  
Sang-Bum Hong
Keyword(s):  
Emergency Department ◽  
Diagnostic Performance ◽  
Complete Blood Count ◽  
White Blood Cells ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Reactive Protein ◽  
Laboratory Test Results ◽  
Early Sepsis

Purpose Monocyte distribution width (MDW) has been suggested as an early biomarker of sepsis, but few studies have compared MDW with conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT). This study evaluated MDW as a biomarker for sepsis and compared it with CRP and PCT. Materials and methods Patients aged 18–80 years who visited the emergency department were screened and prospectively enrolled in a tertiary medical center. Complete blood count, MDW, CRP, and PCT were examined. Diagnostic performance for sepsis was tested using the area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity. Results In total, 665 patients were screened, and 549 patients with valid laboratory test results were included in the analysis. The patients were categorized into three groups according to the Sepsis-3 criteria: non-infection, infection, and sepsis. MDW showed the highest value in the sepsis group (median [interquartile range], 24.0 [20.8–27.8]). The AUC values for MDW, CRP, PCT, and white blood cells for predicting sepsis were 0.71 (95% confidence interval [CI], 0.67–0.75), 0.75 (95% CI, 0.71–0.78], 0.76 (95% CI, 0.72–0.79, and 0.61 (95% CI, 0.57–0.65), respectively. With the optimal cutoff value of the cohort, the sensitivity was 83.0% for MDW (cutoff, 19.8), 69.7% for CRP (cutoff, 4.0), and 76.6% for PCT (cutoff, 0.05). The combination of quick Sequential Organ Failure Assessment (qSOFA) with MDW improved the AUC (0.76; 95% CI, 0.72–0.80) to a greater extent than qSOFA alone (0.67; 95% CI, 0.62–0.72). Conclusions MDW reflected a diagnostic performance comparable to that of conventional diagnostic markers, implying that MDW is an alternative biomarker. The combination of MDW and qSOFA improves the diagnostic performance for early sepsis.

scholarly journals Monocyte Distribution Widths for Early Sepsis Detection in Emergency Department and Comparison with C-reactive Protein and Procalcitonin

2020 ◽  
Author(s):  
Ala woo ◽  
Dong-Kyu Oh ◽  
Chan Jung Park ◽  
Sang-Bum Hong
Keyword(s):  
Emergency Department ◽  
Diagnostic Performance ◽  
Morphological Changes ◽  
White Blood Cells ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Reactive Protein ◽  
Laboratory Test Results ◽  
Early Sepsis

Abstract Background: Monocyte undergo morphological changes in response to infection. Monocyte distribution width (MDW) reflects the morphological changes and increase in septic conditions. Currently, it has been suggested that MDW can act as an early biomarker of sepsis, but there are few reports on the comparison with conventional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT).Methods: Patients who visited the emergency department (ED) were screened and enrolled prospectively. Tests for complete blood count, MDW, CRP, and PCT were done. Diagnostic performance for sepsis was tested in terms of area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity.Results: In total, 665 patients were screened, and 549 patients with validated laboratory test results were included for the analysis. The patients were categorized into three groups according to Sepsis-3 criteria: non-infection, infection, and sepsis. MDW was the highest in the sepsis group (median [Q1-Q3] 24.0 [20.8-27.8]). AUC [95%CI] for MDW, CRP, PCT, and white blood cells for sepsis were 0.71[0.67-0.75], 0.75[0.71-0.78], 0.76[0.72-0.79], and 0.61[0.57-0.65], respectively. With the optimal cut-off value from the cohort, the sensitivity was 85.6% with MDW (cut-off 19.8), 69.7% with CRP (4.0), and 76.6% with PCT (0.05). Combination of quick sequential organ failure score (qSOFA) with MDW and WBC improved the AUC (0.78[CI 0.74-0.82]) to a greater extent compared to qSOFA alone (0.67[CI 0.62-0.72]).Conclusions: MDW reflected comparable diagnostic performance with conventional diagnostic markers, implying that MDW could be an alternative biomarker and that the combination with qSOFA improves the diagnostic performance for early sepsis.

scholarly journals 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

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Pierre Hausfater ◽  
Neus Robert Boter ◽  
Cristian Morales Indiano ◽  
Marta Cancella de Abreu ◽  
Adria Mendoza Marin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Count ◽  
Complete Blood Count ◽  
C Reactive Protein ◽  
Systematic Screening ◽  
Distribution Width ◽  
Sepsis Diagnosis ◽  
Reactive Protein ◽  
Early Sepsis ◽  
Sepsis Detection

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).

scholarly journals The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 39 ◽  
Author(s):  
Emin Daldal ◽  
Hasan Dagmura
Keyword(s):  
Acute Appendicitis ◽  
Laboratory Tests ◽  
Blood Count ◽  
Complete Blood Count ◽  
Lymphoid Hyperplasia ◽  
White Blood Count ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Reactive Protein

Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix—in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values.

Neutrophil CD64 Is an Improved Indicator of Infection or Sepsis in Emergency Department Patients

2006 ◽  
Vol 130 (5) ◽  
pp. 654-661 ◽  
Author(s):  
Bruce H. Davis ◽  
Stephen H. Olsen ◽  
Ejaz Ahmad ◽  
Nancy C. Bigelow
Keyword(s):  
Emergency Department ◽  
Sedimentation Rate ◽  
Diagnostic Tests ◽  
Diagnostic Performance ◽  
Tertiary Care ◽  
Clinical Score ◽  
C Reactive Protein ◽  
Cd64 Expression ◽  
Reactive Protein ◽  
Neutrophil Cd64

Abstract Context.—Sepsis, affecting millions of individuals annually with an associated high mortality rate, is among the top 10 causes of death. In addition, improvements in diagnostic tests for detecting and monitoring sepsis and infection have been limited in the last 25 years. Neutrophil CD64 expression has been proposed as an improved diagnostic test for the evaluation of infection and sepsis. Objective.—To evaluate the diagnostic performance of a quantitative flow cytometric assay for leukocyte CD64 expression in comparison with the standard tests for infection/sepsis in an ambulatory care setting. Design.—Prospective analysis of 100 blood samples from patients from an emergency department setting in a 965-bed tertiary care suburban community hospital was performed for neutrophil CD64 expression, C-reactive protein, erythrocyte sedimentation rate, and complete blood count. The laboratory findings were compared with a clinical score for the likelihood of infection/sepsis, which was obtained by a blinded retrospective chart review. Results.—The diagnostic performance, as gauged by the clinical score, varied with neutrophil CD64 (sensitivity 87.9%, specificity 71.2%, efficiency 76.8%) and outperformed C-reactive protein (sensitivity 88.2%, specificity 59.4%, efficiency 69.4%), absolute neutrophil count (sensitivity 60.0%, specificity 50.8%, efficiency 53.8%), myeloid left shift (sensitivity 68.2%, specificity 76.3%, efficiency 73.3%), and sedimentation rate (sensitivity 50.0%, specificity 65.5%, efficiency 61.0%). Conclusion.—Neutrophil CD64 expression quantitation provides improved diagnostic detection of infection/sepsis compared with the standard diagnostic tests used in current medical practice.

scholarly journals Diagnostic Performance of Red Cell Distribution Width in Adult Iraqi Patients with Ankylosing Spondylitis

Arthritis ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Faiq I. Gorial ◽  
Ali M. Hassan
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Complete Blood Count ◽  
Activity Index ◽  
Disease Activity Index ◽  
Red Cell ◽  
Cell Distribution ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Reactive Protein

Background. Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that leads to structural damage, functional impairment, and decrease in the quality of life. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability. Objective. To analyse RDW in patients with AS and to evaluate the relationships with acute phase reactants (APRs) and disease activity index. Patients and Methods. A total of 100 patients with AS (78 males and 22 females) were diagnosed according to the modified New York classification criteria for AS and 146 (99 males: 47 females) healthy individuals matched in age and sex as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were measured. Results. The mean age for patients and controls was 38.0 ± 9.0 and 35.8 ± 9.0 years, respectively (p=0.057). RDW was significantly higher in patients with AS compared with controls (14.133 ± 1.613 versus 12.299 ± 1.031, p < 0.001). There was a direct correlation of RDW with both ESR and CRP (P < 0.001); RDW had r=0.38 for C-reactive protein (CRP) and r=0.413 for ESR. Also BASDAI was directly correlated with RDW (r=0.326 p<0.001). RDW was a valid measure to differentiate between patients with AS and controls (AUC=0,84, p<0.001) and at optimum cut-off value>13% has highest accuracy (78.9%) with very good sensitivity test (81%) and NPV (85.6%) as well as good specificity (77.4%) and PPV (71.1%). Conclusion. RDW was higher in AS patients compared with controls and was directly correlated with ESR, CRP, and BASDAI. RDW was a valid simple measure with good accuracy to differentiate between patients with AS and controls.

scholarly journals #83: Leukocytes and C-Reactive Protein Levels in Children with Influenza-positive and Influenza-negative Viral Pneumonia in a Third-level Pediatric Center in Mexico City from 2011 to 2016

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
G H Cristerna Tarrasa ◽  
N González Saldaña ◽  
M Hernández Porras ◽  
S Fortes Gutiérrez
Keyword(s):  
Complete Blood Count ◽  
White Blood Cells ◽  
H1n1 Influenza ◽  
Viral Pneumonia ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Influenza Pneumonia ◽  
Syncytial Virus ◽  
Student’S T

Abstract Background Influenza has been a major source of morbidity and mortality worldwide. Children are one of the most susceptible groups for severe influenza. Clinical differentiation between viral and bacterial pneumonia is difficult to assess in children, so the aid of the complete blood count (CBC) and C-reactive protein (CRP) are used to differentiate between them. However, differential diagnosis between influenza-positive and -negative viral pneumonia is difficult. CRP levels have been found to be higher in H1N1 influenza adult patients. However, there are no studies regarding CBC, and CRP levels in pediatric patients with influenza-positive and -negative pneumonia. Methods From 2011 to 2016, we found children less than 18 years old with viral pneumonia who had positive viral RT–PCR test for adenovirus, bocavirus, influenza, parainfluenza, metapneumovirus, rhinovirus, coronavirus or respiratory syncytial virus (RSV). Means for white blood cells (WBC), neutrophils, lymphocytes and CRP were calculated. Comparisons between influenza and other respiratory viral pneumonia WBC and CRP means were made. Student’s t-test was used for statistical analysis. Results We analyzed 183 patients with positive viral pneumonia cases; of which, 37 (20.2%) had two viruses detected. Mean age was 1 year old and 56.5% were male. Viral detections were rhinovirus 75 (40.9%), RSV 45 (24.5%), influenza 31 (16.9%), metapneumovirus 30 (16.3%), bocavirus 20 (10.9%), parainfluenza 14 (7.6%), coronavirus 3 (1.6%) and adenovirus 2 (1.1%). Mean influenza WBC were 10,900 ± 2040/μL, neutrophils were 6998 ± 1510/μL, lymphocytes 2882 ± 826/μL and CRP 5.41 ± 1.9 mg/dL. Mean influenza negative, viral-positive pneumonia were WBC 12227 ± 868/μL, neutrophils 6787 ± 696/μL, lymphocytes 4469 ± 426/μL, CRP 2.81 ± 0.56 mg/dL. Lower lymphocyte counts (P = 0.002) and higher CRP levels (P = 0.019) were found in patients with influenza comparing them with pneumonia caused by other viruses. Conclusions In our study, children with positive influenza pneumonia showed lower levels of lymphocytes and higher levels of CRP compared with negative influenza. Lower lymphocyte counts and high CRP levels have been found in influenza-positive patients mainly in adult studies. In children with suspected influenza pneumonia, lower lymphocyte counts and higher CRP levels can aid clinical diagnosis before molecular confirmation in influenza pneumonia.

scholarly journals Predicting Mechanical Ventilation For More Than 7 Days In The Emergency Department

2021 ◽  
Author(s):  
Jin Hui Paik ◽  
Jung-Soo Kim ◽  
Man-Jong Lee ◽  
Mi Hwa Park ◽  
Areum Durey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Underlying Disease ◽  
Test Results ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Factors Influencing ◽  
Laboratory Test Results ◽  
The Mean ◽  
Underlying Diseases

Abstract Background: The duration of mechanical ventilation (MV) required by patients admitted to the emergency department (ED) is difficult to predict. We investigated the duration of MV in ED-admitted patients, as well as their clinical progress.Methods: We investigated the duration of MV in adult patients (aged ≥18 years) who were attached to ventilators in our ED between January and December 2017. The patients were divided into two groups; MV <7 days and MV ≥7 days. The patients’ demographic characteristics, diagnoses, clinical features, and underlying diseases were compared between two groups.Results: The study comprised 282 patients including 142 in the MV <7 days group and 140 in the MV ≥7 days group. The MV ≥7 days group had more patients diagnosed with metabolic disorder, pneumonia, neurological disease, sepsis, and multiple trauma, and also had a greater proportion of patients with dementia or stroke as the underlying disease. The mean C-reactive protein level in the MV ≥7 days group was 6.4 mg/dL, which was higher than that in the MV <7 days group. The risk factors for requiring ≥7 days of MV were identified as a diagnosis of stroke as well as having the underlying diseases of cancer and stroke or dementia. Among the laboratory test results, pH, HCO3- , and albumin <3.5 g/dL were identified as factors influencing the duration of MV.Conclusions: MV for ≥7 days is predicted to be required for patients admitted for a stroke; those with underlying cancer or stroke; and those with adverse pH, HCO3-, and albumin blood test results.

scholarly journals Laboratory features in severe vs. non-severe COVID-19 patients, a systematic review and meta-analysis

2020 ◽  
Author(s):  
Sulmaz Ghahramani ◽  
Reza Tabrizi ◽  
Kamran B Lankarani ◽  
Seyyed mohammad amin Kashani ◽  
Shahla Rezaei ◽  
...  
Keyword(s):  
Troponin I ◽  
Meta Analysis ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Protein Ratio ◽  
Reactive Protein ◽  
Laboratory Test Results ◽  
Laboratory Features ◽  
Severe Group ◽  
Mean Differences

Abstract OBJECTIVE: Understanding the common laboratory features of COVID-19 in severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. MATERIALS AND METHODS: Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of ‎Science, and Google Scholar from inception to 3rd of March 2020. Heterogeneity across included ‎studies was determined using Cochrane’s Q test and the I2 statistic. We used the fixed or random-effect models to pool ‎the weighted mean differences (WMDs) or standardized mean differences and 95% confidence ‎intervals (CIs).‎RESULTS:‎ Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapour) with 3396 ranging from 12-1099 patients, ‎were included. Our meta-analyses showed a significant decrease in ‎lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the ‎neutrophil, alanine ‎aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose ‎level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. However, no significant changes were observed in white blood cells (WBC), ‎ creatine kinase (CK), troponin I, myoglobin, interleukin-6 (IL-6), and potassium (K) between the two groups.‎CONCLUSIONS: This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of hospital admission. Future well-methodologically designed studies from other populations are strongly recommended.

scholarly journals Predicting Mechanical Ventilation for More Than 7 Days in the Emergency Department

2021 ◽  
Author(s):  
Jin Hui Paik ◽  
Jung-Soo Kim ◽  
Man-Jong Lee ◽  
Mi Hwa Park ◽  
Areum Durey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Underlying Disease ◽  
Test Results ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Factors Influencing ◽  
Laboratory Test Results ◽  
The Mean ◽  
Underlying Diseases

Abstract Background The duration of mechanical ventilation (MV) required by patients admitted to the emergency department (ED) is difficult to predict. We investigated the duration of MV in ED-admitted patients, as well as their clinical progress.Methods We investigated the duration of MV in adult patients (aged ≥18 years) who were attached to ventilators in our ED between January and December 2017. The patients were divided into two groups; MV <7 days and MV ≥7 days. The patients’ demographic characteristics, diagnoses, clinical features, and underlying diseases were compared between two groups.Results The study comprised 282 patients including 142 in the MV <7 days group and 140 in the MV ≥7 days group. The MV ≥7 days group had more patients diagnosed with metabolic disorder, pneumonia, neurological disease, sepsis, and multiple trauma, and also had a greater proportion of patients with dementia or stroke as the underlying disease. The mean C-reactive protein level in the MV ≥7 days group was 6.4 mg/dL, which was higher than that in the MV <7 days group. The risk factors for requiring ≥7 days of MV were identified as a diagnosis of stroke as well as having the underlying diseases of cancer and stroke or dementia. Among the laboratory test results, pH, HCO3- , and albumin <3.5 g/dL were identified as factors influencing the duration of MV.Conclusion MV for ≥7 days is predicted to be required for patients admitted for a stroke; those with underlying cancer or stroke; and those with adverse pH, HCO3-, and albumin blood test results.

Sign in / Sign up

Export Citation Format

Share Document