Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department

2020 ◽  
Vol 58 (11) ◽  
pp. 1951-1957 ◽  
Author(s):  
Luisa Agnello ◽  
Giulia Bivona ◽  
Matteo Vidali ◽  
Concetta Scazzone ◽  
Rosaria Vincenza Giglio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Early Identification ◽  
Screening Tool ◽  
Complete Blood Count ◽  
Sepsis Group ◽  
Control Group ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Patients At Risk

AbstractObjectivesThe diagnosis of sepsis in the Emergency Department (ED) is challenging and a reliable biomarker is needed. The current study aimed to evaluate the diagnostic accuracy of monocyte distribution width (MDW) for the early identification of sepsis in the ED.MethodsWe performed a large observational study including consecutive adult patients (≥18 years of age) presenting to the ED between September and November 2019, with an order for complete blood count (CBC) evaluation. A total of 2,215 patients were enrolled and classified based on Sepsis-2 criteria as the control group (1,855), infection group (172), Systemic Inflammatory Response Syndrome (SIRS) group (100), and sepsis group (88).ResultsMDW levels were higher in patients with sepsis than in all other groups (p<0.001). ROC curve analysis showed an optimal diagnostic accuracy of MDW for sepsis prediction at a cut-off point of 23.5, with an AUC of 0.964, sensitivity and specificity of 0.920 and 0.929, respectively.ConclusionsOur findings encourage further investigation to validate the use of MDW as a screening tool for the early identification of patients at risk of sepsis in the ED.

scholarly journals Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1292
Author(s):  
Luisa Agnello ◽  
Alessandro Iacona ◽  
Salvatore Maestri ◽  
Bruna Lo Sasso ◽  
Rosaria Vincenza Giglio ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Early Detection ◽  
Diagnostic Accuracy ◽  
Positive Likelihood Ratio ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Independent Validation ◽  
Sepsis Screening

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6–32.9) and SI (median 1.15, IQR 1.05–1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

scholarly journals A new tool for sepsis screening in the Emergency Department

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luisa Agnello ◽  
Alessandro Iacona ◽  
Bruna Lo Sasso ◽  
Concetta Scazzone ◽  
Michele Pantuso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Systemic Inflammatory Response Syndrome ◽  
Diagnostic Accuracy ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Index Value ◽  
Sepsis Screening ◽  
Substantial Change

Abstract Objectives In this study, we developed and evaluated the diagnostic accuracy of the Sepsis Index for early sepsis screening in the Emergency Department (ED). Methods Sepsis Index is based on the combination of monocyte distribution width (MDW) and mean monocyte volume (MMV). Sepsis Index≥1 was selected to define sepsis. We tested its diagnostic accuracy in an ED population stratified in four groups: controls, Systemic Inflammatory Response Syndrome (SIRS), infection, and sepsis, according to Sepsis-2 criteria. Results Patients with sepsis displayed higher median Sepsis Index value than patients without sepsis. At the receiver operating characterictis (ROC) curve analysis for the prediction of sepsis, the area under the curve (AUC) of MDW and Sepsis Index were similar: 0.966 (95%CI 0.947–0.984), and 0.964 (95%CI 0.942–0.985), respectively. Sepsis Index showed increased specificity than MDW (94.7 vs. 90.6%), without any decrease in sensitivity (92.0%). Additionally, LR+ increased from 9.8 (MDW) to 17.4 (Sepsis Index), without any substantial change in LR− (respectively 0.09 vs. 0.08). Finally, PPV increased from 0.286 (MDW) to 0.420 (Sepsis Index). Conclusions Sepsis Index improves the diagnostic accuracy of MDW alone for sepsis screening.

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.

Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Esin Merve Erol Koç ◽  
Rahime Bedir Fındık ◽  
Hatice Akkaya ◽  
Işılay Karadağ ◽  
Eda Özden Tokalıoğlu ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Perinatal Outcomes ◽  
Control Group ◽  
Strong Positive Correlation ◽  
Monocyte Count ◽  
Distribution Width ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference ◽  
Adverse Perinatal Outcomes

AbstractObjectivesTo evaluate the relationship between Coronavirus Disease 2019 (COVID-19) in pregnancy and adverse perinatal outcomes. The secondary aim is to analyze the diagnostic value of hematologic parameters in COVID-19 complicated pregnancies.MethodsThe current study is conducted in a high volume tertiary obstetrics center burdened by COVID-19 pandemics, in Turkey. In this cohort study, perinatal outcomes and complete blood count indices performed at the time of admission of 39 pregnancies (Study group) complicated by COVID-19 were compared with 69 uncomplicated pregnancies (Control group).ResultsThere was no significant difference between the obstetric and neonatal outcomes of pregnancies with COVID-19 compared to data of healthy pregnancies, except the increased C-section rate (p=0.026). Monocyte count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) were significantly increased (p<0.0001, p=0.009, p=0.043, p<0.0001, respectively) whereas the MPV and plateletcrit were significantly decreased (p=0.001, p=0.008) in pregnants with COVID-19. ROC analysis revealed that the optimal cut-off value for MLR was 0.354 which indicated 96.7% specificity and 59.5% sensitivity in diagnosis of pregnant women with COVID-19. A strong positive correlation was found between the MLR and the presence of cough symptom (r=41.4, p=<0.0001).ConclusionsThe study revealed that, pregnancies complicated by COVID-19 is not related with adverse perinatal outcomes. MLR may serve as a supportive diagnostic parameter together with the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in assessment of COVID-19 in pregnant cohort.

Monocyte distribution width (MDW): a useful biomarker to improve sepsis management in Emergency Department

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Donatella Poz ◽  
Danila Crobu ◽  
Elena Sukhacheva ◽  
Marco Bruno Luigi Rocchi ◽  
Maria Chiara Anelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Sepsis Group ◽  
Differential Analysis ◽  
Clinical Value ◽  
Sepsis Management ◽  
Distribution Width ◽  
Standard Clinical Practice

Abstract Objectives Sepsis is a time-dependent and life-threating condition. Despite several biomarkers are available, none of them is completely reliable for the diagnosis. This study aimed to evaluate the diagnostic utility of monocyte distribution width (MDW) to early detect sepsis in adult patients admitted in the Emergency Department (ED) with a five part differential analysis as part of the standard clinical practice. Methods A prospective cohort study was conducted on 985 patients aged from 18 to 96 and included in the study between November 2019 and December 2019. Enrolled subjects were classified into four groups based on sepsis-2 diagnostic criteria: control, Systemic Inflammatory Response Syndrome (SIRS), infection and sepsis. The hematology analyzer DxH 900 (Beckman Coulter Inc.) provides the new reportable parameter MDW, included in the leukocyte 5 part differential analysis, cleared by Food and Drug administration (FDA) and European Community In-Vitro-Diagnostic Medical Device (CE IVD) marked as early sepsis indicator (ESId). Results MDW was able to differentiate the sepsis group from all other groups with Area Under the Curve (AUC) of 0.849, sensitivity of 87.3% and specificity of 71.7% at cut-off of 20.1. MDW in combination with white blood cell (WBC) improves the performance for sepsis detection with a sensitivity increased up to 96.8% when at least one of the two biomarkers are abnormal, and a specificity increased up to 94.6% when both biomarkers are abnormal. Conclusions MDW can predict sepsis increasing the clinical value of Leukocyte 5 Part Differential analysis and supporting the clinical decision making in sepsis management at the admission to the ED.

Evaluation of platelet parameters in cerebral stroke in patients with HIV infection

2021 ◽  
pp. 48-51
Author(s):  
D. O. Tarasov ◽  
I. A. Lebedev ◽  
S. N. Suplotov ◽  
O. A. Nesterova ◽  
G. O. Tersenov ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Hiv Infection ◽  
Complete Blood Count ◽  
Blood Platelets ◽  
High Volume ◽  
Hiv Positive ◽  
Control Group ◽  
Cerebral Stroke ◽  
Giant Platelets ◽  
Distribution Width

The article reflects the results of studying platelet parameters in HIV-positive patients with different types of stroke.Aim. To identify changes in laboratory parameters of a complete blood count which characterize the morphofunctional features of platelets in stroke among HIV-positive patients.Materials and methods. 110 HIV-positive patients who received treatment for stroke in hospitals of the Tyumen region were examined. The study of blood parameters was carried out at the analyzer Sysmex XE2100 (Japan). Blood sampling was carried out on the day of patients admission.The number of platelets and platelet indices were analyzed: MPV – mean platelet volume, PDW – platelet distribution width, PCT – plateletcrit and P-LCR – platelet large cell ratio. The control group consisted of 117 patients. The signifcance of the differences was determined at the twotailed signifcance level of p < 0.05.Results. There was a signifcant decrease in the number of platelets (p < 0.05), in average, on 34.3% among patients with hemorrhages and HIV infection. Among patients with ischemic stroke this decrease was less pronounced (p = 0.05). A signifcant decrease in plateletcrit was established among patients with intracranial hemorrhages, while it did not change signifcantly among patients with cerebral infarction. During evaluation of other platelet parameters, no signifcant differences were found between patients in experimental and control groups. The coeffcient of giant platelets prevailed by one and a half times in patients with hemorrhages associated with HIV infection, which turned out to be beyond the statistical signifcance.Conclusion. The presence of HIV infection leads to a more pronounced, reliable decrease in the number of platelets and plateletcrit among patients that have acute phase of the development of hemorrhagic stroke than in patients with cerebral infarction. The development of intracranial hemorrhage among HIV-positive patients is characterized by an increase of blood platelets with a high volume, the level of which increased by one and a half times being beyond the statistical signifcance and having as a leading mechanism the intensifcation of platelet formation in the bone marrow.

scholarly journals Comparison of Serum Creatinine and Cystatin C for Early Diagnosis of Contrast-Induced Nephropathy after Coronary Angiography and Interventions

2012 ◽  
Vol 58 (2) ◽  
pp. 458-464 ◽  
Author(s):  
Flavio Ribichini ◽  
Giovanni Gambaro ◽  
Maria Stella Graziani ◽  
Michele Pighi ◽  
Gabriele Pesarini ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Diagnostic Accuracy ◽  
Cystatin C ◽  
Roc Curve ◽  
Diagnostic Value ◽  
Roc Curve Analysis ◽  
Contrast Induced Nephropathy ◽  
Early Predictors ◽  
Patients At Risk

Abstract BACKGROUND The diagnostic accuracy of serum creatinine and cystatin C (Cys) as early predictors of contrast-induced nephropathy (CIN) has been debated. We investigated the diagnostic sensitivities, diagnostic specificities, and variations from baseline for serum creatinine and Cys in CIN. METHODS We prospectively evaluated 166 patients at risk for CIN at baseline, and at 12, 24, and 48 h after exposure to contrast media. CIN occurred in 30 patients (18%). Changes (Δ) compared to baseline in serum creatinine and Cys were evaluated at the predefined time points. ROC curve analysis was performed for the Δ 12-h basal serum creatinine and Cys. RESULTS The Δ serum creatinine at 12 h from baseline was the earliest predictor of CIN [area under the ROC curve (AUC) = 0.80; P &lt; 0.001]. The Δ serum creatinine 15% variation [0.15 mg/dL (13.2 μmol/L)] yielded 43% diagnostic sensitivity and 93% diagnostic specificity. The ΔCys at 12 h from baseline performed significantly worse than serum creatinine (AUC = 0.48; P = 0.74). CONCLUSIONS Variations from the serum creatinine baseline offer better diagnostic accuracy for predicting CIN at an earlier stage than similar variations in Cys. An additional diagnostic value of Cys over the determination of serum creatinine in the setting of CIN was not observed.

scholarly journals Study the relationship between nasal polyps, platelet count, mean platelet volume, neutrophil/lymphocyte ratio in patients attending otolaryngology OPD in a tertiary care teaching hospital, West Bengal

2017 ◽  
Vol 3 (2) ◽  
pp. 228
Author(s):  
Manuprita Sharma ◽  
Santosh Raman ◽  
Bidhan Ray ◽  
Rupali Verma Bagga ◽  
Ramesh Kumar Sahu ◽  
...  
Keyword(s):  
Platelet Count ◽  
Nasal Polyp ◽  
Mean Platelet Volume ◽  
Complete Blood Count ◽  
Tertiary Care ◽  
Control Group ◽  
Blood Cell Count ◽  
Platelet Volume ◽  
Distribution Width ◽  
The Relationship

<p class="abstract"><strong>Background:</strong> Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in hemostasis, tissue repairing and inflammation. Recently, mean platelet volume (MPV) was recognized as a simple inflammatory marker in the inflammatory disease<span lang="EN-IN">. </span>This study investigated the relationship of nasal polyps with MPV (mean platelet volume), platelet count and NLR (neutrophil to lymphocyte ratio).</p><p class="abstract"><strong>Methods:</strong> The cross-sectional observational study we investigated CBC (complete blood count) parameters of the patients that consulted ENT clinic in a tertiary care teaching hospital, Haldia because of nasal polyp. <span>About 76 patients and 42 controls were included in this study. In all groups, WBC (white blood cell count), RBC (red blood cell count), RDW (red cell distribution width), platelet count, MPV, PDW (platelet distribution width) and NLR parameters from CBC (complete blood count) were compared between patients and controls</span><span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> Mean WBC values were 6.89±1.33×103/μL in patients with NPs, vs. 7.11±2.32×103/μL in the control group. Mean haemoglobin (Hb) values were 13.19±1.34 g/dL in patients with NPs, vs. 14.1±1.67 g/dl in the control group. Mean MPV values were 9.11 ± 1.08 fL in patients with NPs, vs. 8.32±0.53 fL in the control group. Mean PLT values were 232.38 ± 39.97×103/μL in patients with NPs, vs. 271.44±45.14×103 in the control group. MPV was higher in nasal polyp patients, whereas platelet count was higher in controls. The difference was significant for the mean absolute neutrophil, platelet count, and lymphocyte counts, NLR, PDW and MPV values between the study group and the control group<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Platelet count and NLR were significantly lower in patients than the controls, whereas MPV was significantly higher in nasal polyp patients<span lang="EN-IN">.</span></p>

scholarly journals EVALUATING SOME OF THE HEMATOLOGICAL PARAMETERS FOR HELICOBACTER PYLORI INFECTED PATIENTS

2020 ◽  
Vol 17 (36) ◽  
pp. 1052-1060
Author(s):  
Nidhal Abdullah HASHIM ◽  
Younus Jasim ABDULLAH ◽  
Hasan Rahman SHAWI
Keyword(s):  
Helicobacter Pylori ◽  
Complete Blood Count ◽  
Hematological Parameters ◽  
Control Group ◽  
Mean Corpuscular Hemoglobin ◽  
Healthy Individuals ◽  
Corpuscular Hemoglobin ◽  
Distribution Width ◽  
Significant Difference ◽  
H Pylori

Helicobacter pylori are Gram-negative curved rods that habitats the gastric mucosa and considered as the leading causes of stomach ulcers and duodenal ulcers in humans. The main object of this study was to evaluate the influences of the bacteria on several hematological parameters. A total of 60 patients aged between 15 to 40 years were included in this study (30 male and 30 female) in addition to 30 healthy individuals from the same ages who were considered as a control group. Venous blood (4 ml) was obtained from the study population and investigated for complete blood count (CBC) using an automated hematology analyzer. The results revealed that there is a substantial decrease (p 0.01) in Hemoglobin (Hb), Red cell distribution width (RDW), and mean corpuscular hemoglobin (MCH) in patients compared to control. However, no significant difference in Red blood cells (RBCs), Hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) in patients compared to control. Also, no significant differences were found in the white blood cell (WBC) between H. pylori infected and non-infected persons. Otherwise, there are significant differences (p 0.01) in lymphocytes, monocytes, granulocytes in the patients and healthy individuals. The results also found that there are significant statistical differences in some of the hematologic parameters among study groups according to their gender. The study concluded that Hb, RDW, lymphocytes, monocytes, granulocytes are decreased in H. Pylori infected patients suggesting that infection may have direct effects on blood parameters.

scholarly journals The relationship of the immature platelet fraction with the diagnosis and severity of acute bronchiolitis in children.

2020 ◽  
Author(s):  
MURAT DOĞAN ◽  
MEHMET KOSE ◽  
Mehmet ÖZTÜRK ◽  
melih hangul ◽  
HÜMEYRA ASLANER
Keyword(s):  
Roc Curves ◽  
Clinical Severity ◽  
Control Group ◽  
Healthy Children ◽  
Acute Bronchiolitis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Immature Platelet Fraction ◽  
Severity Of The Disease ◽  
Relationship Of

Objective: Acute bronchiolitis is one of the most common causes of hospitalization for children younger than 1 year. Although the prognosis for these children is generally good, the condition involves a risk of mortality. Here, we evaluate the immature platelet fraction (IPF) as a biomarker for the severity of acute bronchiolitis. Material and Methods: In total, 179 children who had been diagnosed with acute bronchiolitis were classified into three groups: mild, moderate, and severe bronchiolitis, and 80 healthy children were included as a control group. The diagnostic capacity of the IPF, mean platelet volume (MPV), platelet distribution width (PDW), white blood cell count (WBC), and platelet count (PLT) values to predict bronchiolitis was evaluated using receiver operating characteristic (ROC) curves and their respective areas under the curves (AUCs) calculated with 95% confidence intervals. Results: Patients with acute bronchiolitis had a larger IPF than their healthy counterparts (p < 0.001). Additionally, a positive correlation was observed between the clinical severity of the disease and the IPF. The ROC curve analysis indicated that the IPF cut-off point for predicting acute bronchiolitis was >3.2%, with a sensitivity of 84% and specificity of 97%. Our results clearly demonstrate that the AUCs for IPF, MPV, PDW, WBC, and PLT were statistically significant for the bronchiolitis versus the control group. The AUC was greatest for the IPF. Conclusion: The IPF is a new marker for diagnosing and evaluating the clinical severity of acute bronchiolitis.

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