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.

scholarly journals Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2 Emergency Department Cohort

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 618 ◽  
Author(s):  
Brandon Michael Henry ◽  
Justin Lee Benoit ◽  
Stefanie Benoit ◽  
Christina Pulvino ◽  
Brandon A. Berger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Severe Illness ◽  
Cell Distribution ◽  
Laboratory Assessment ◽  
Distribution Width ◽  
Red Blood Cell Distribution

Since previous evidence has demonstrated that red blood cell distribution width (RDW) may be a useful prognostic parameter in many critical illnesses and infectious diseases, we investigated the utility of RDW for monitoring patients with coronavirus disease 2019 (COVID-19). The study population consisted of 49 COVID-19 patients, including 16 (32.6%) with severe illness, 12 (24.5%) with severe acute kidney injury (AKI), and 8 (16.3%) requiring renal replacement therapy (RRT). The predictive value of blood tests, performed during emergency department evaluation, was then addressed. A progressive increase of RDW was observed with advancing COVID-19 severity. The area under the curve (AUC) of RDW was 0.73 for predicting severe illness, 0.80 for severe AKI, and 0.83 for RRT, respectively. In multivariate analysis, elevated RDW was associated with 9-fold and 16-fold increased odds of severe COVID-19 and AKI, respectively. The results of this study suggest that RDW should be part of routine laboratory assessment and monitoring of COVID-19.

Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) – Development, internal and external validation of a prediction model

2021 ◽  
Vol 20 (1) ◽  
pp. 4-14
Author(s):  
K. Azijli ◽  
◽  
A.W.E. Lieveld ◽  
S.F.B. van der Horst ◽  
N. de Graaf ◽  
...  
Keyword(s):  
Emergency Department ◽  
Prediction Model ◽  
Clinical Decision Making ◽  
Prediction Models ◽  
External Validation ◽  
Model Performance ◽  
Area Under The Curve ◽  
Brier Score ◽  
Multi Centre Study ◽  
Poor Outcome

Background: A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed. Objective: Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome. Methods: In this prospective, multi-centre study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort. Results: We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75). Conclusion: The COVERED risk score showed excellent discriminatory ability, also in external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.

scholarly journals FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis

2019 ◽  
Vol 8 (1) ◽  
pp. 187-191
Author(s):  
Alexa Profozich ◽  
Trevor Sytsma ◽  
Ryan Arnold ◽  
Kristen Miller ◽  
Muge Capan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Initial Point ◽  
Clinical Decision ◽  
Sepsis Management ◽  
Insight Into

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

scholarly journals Opinion paper on innovative approach of biomarkers for infectious diseases and sepsis management in the emergency department

2013 ◽  
Vol 51 (6) ◽  
Author(s):  
Salvatore Di Somma ◽  
Laura Magrini ◽  
Francesco Travaglino ◽  
Irene Lalle ◽  
Nicola Fiotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Organ Failure ◽  
Critically Ill ◽  
Scoring Systems ◽  
Sepsis Management ◽  
Distribution Width ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Risk Of Death ◽  
Diagnosis And Prognosis ◽  
Inducible Protein

AbstractSepsis is a leading healthcare problem, accounting for the vast majority of fatal events in critically ill patients. Beyond early diagnosis and appropriate treatment, this condition requires a multifaceted approach for monitoring the severity, the potential organ failure as well as the risk of death. Monitoring of the efficacy of treatment is also a major issue in the emergency department (ED). The assessment of critically ill conditions and the prognosis of patients with sepsis is currently based on some scoring systems, which are, however, inefficient to provide definite clues about organ failure and prognosis in general. The discretionary and appropriate use of some selected biomarkers such as procalcitonin, inducible protein 10 (IP10), Group IV phospholipase A2 type II (PLA2 II), neutrophil gelatinase-associated lipocalin (NGAL), natriuretic peptides, mature adrenomedullin (ADM), mid-regional pro-adrenomedullin (MR-proADM), copeptin, thrombopoietin, Mer receptor and even red blood cell distribution width (RDW) represent thereby an appealing perspective in the diagnosis and management of patients with sepsis. Nevertheless, at the moment, it is not still clear if it is better to use a multimarkers approach or if a single, most appropriate, biomarker exists. This collective opinion paper is aimed at providing an overview about the potential clinical usefulness of some innovative biomarkers of sepsis in its diagnosis and prognosis, but also in the treatment management of the disease. This manuscript represents a synopsis of the lectures of Third Italian GREAT Network Congress, that was hold in Rome, 15–19 October 2012.

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 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 Diagnostic Value of Thromboelastography (TEG) for the Diagnosis of Death in Infected Patients

2021 ◽  
Vol 27 ◽  
pp. 107602962110472
Author(s):  
Jingchao Xuan ◽  
Junyu Wang ◽  
Bing Wei
Keyword(s):  
Area Under The Curve ◽  
Maximum Amplitude ◽  
Diagnostic Value ◽  
Correlation Study ◽  
Infection Site ◽  
Clinical Value ◽  
Diagnostic Efficacy ◽  
Distribution Width ◽  
Α Angle ◽  
Diagnosis Of Death

In this study, we want to investigate the clinical value of each index of thromboelastography (TEG) on the prognosis of infected patients. The clinical baseline data and TEG test results of 431 infected patients in our hospital’s emergency department between January 2018 and December 2018 were selected. And the patients were divided into death and survival groups to analyze the predictive value of each index of TEG and the joint model on the death of infected patients. In the correlation study of C-reactive protein (CRP) and procalcitonin (PCT) with each TEG parameter, CRP was positively correlated with maximum amplitude (MA, r  =  0.145, P  =  .003) and elasticity constants (E, r  =  0.098, P  =  .043), respectively. PCT was positively correlated with coagulation reaction time (R, r  =  0.124, P  =  .010) and time to MA (TMA) ( r  =  0.165, P  =  .001), respectively; PCT was negatively correlated with α-Angle ( r  =  0.124, P  =  .010) and coagulation index (CI, r  =  −0.108, P  =  .026), respectively. Multifactorial regression analysis showed that granulocytes, thrombocytes, platelet distribution width (PDW), and infection site were independent influences on infected patients’ death. Diagnostic data showed that all eight TEG indicators had good specificity for predicting death, but all had poor sensitivity; thrombodynamic potential index (TPI) had the best diagnostic value (area under the curve, AUC  =  0.609, P  =  .002). The eight-indicator modeling of TEG showed that the TEG model combined with PCT and CRP, respectively, had lower diagnostic efficacy than PCT (AUC  =  0.756, P < .001); however, TEG had better specificity (82.73%) when diagnosed independently. The granulocytes, thrombocytes, PDW, and infection site are independent influencing factors of death in infected patients. Each index of TEG has better specificity in the diagnosis of death in infected patients.

scholarly journals A radiomics-based nomogram for preoperative T staging prediction of rectal cancer

2021 ◽  
Author(s):  
Xue Lin ◽  
Sheng Zhao ◽  
Huijie Jiang ◽  
Fucang Jia ◽  
Guisheng Wang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Locally Advanced ◽  
Area Under The Curve ◽  
Training Dataset ◽  
Validation Dataset ◽  
Prospective Analysis ◽  
Clinical Value

Abstract Purpose To investigate the value of a radiomics-based nomogram in predicting preoperative T staging of rectal cancer. Methods A total of 268 eligible rectal cancer patients from August 2012 to December 2018 were enrolled and allocated into two datasets: training (n = 188) and validation datasets (n = 80). Another set of 32 patients from January 2019 to July 2019 was included in a prospective analysis. Pretreatment T2-weighted images were used to radiomics features extraction. Feature selection and radiomics score (Rad-score) construction were performed through a least absolute shrinkage and selection operator regression analysis. The nomogram, which included Rad-scores and clinical factors, was built using multivariate logistic regression. Discrimination, calibration, and clinical utility were used to evaluate the performance of the nomogram. Results The Rad-score containing nine selected features was significantly related to T staging. Patients who had locally advanced rectal cancer (LARC) generally had higher Rad-scores than patients with early-stage rectal cancer. The nomogram incorporated Rad-scores and carcinoembryonic antigen levels and showed good discrimination, with an area under the curve (AUC) of 0.882 (95% confidence interval [CI] 0.835–0.930) in the training dataset and 0.846 (95% CI 0.757–0.936) in the validation dataset. The calibration curves confirmed high goodness of fit, and the decision curve analysis revealed the clinical value. A prospective analysis demonstrated that the AUC of the nomogram to predict LARC was 0.859 (95% CI 0.730–0.987). Conclusion A radiomics-based nomogram is a novel method for predicting LARC and can provide support in clinical decision making.

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 The Clinical Value of GDF15 and Its Prospective Mechanism in Sepsis

2021 ◽  
Vol 12 ◽  
Author(s):  
Huan Li ◽  
Dongling Tang ◽  
Juanjuan Chen ◽  
Yuanhui Hu ◽  
Xin Cai ◽  
...  
Keyword(s):  
Nuclear Translocation ◽  
Organ Damage ◽  
Dynamic Monitoring ◽  
Sepsis Group ◽  
Inflammatory Factors ◽  
Control Group ◽  
Regulatory Effect ◽  
Clinical Value ◽  
Inflammatory State

Growth differentiation factor 15 (GDF15) is involved in the occurrence and development of many diseases, and there are few studies on its relationship with sepsis. This article aims to explore the clinical value of GDF15 in sepsis and to preliminarily explore its prospective regulatory effect on macrophage inflammation and its functions. We recruited 320 subjects (132 cases in sepsis group, 93 cases in nonsepsis group, and 95 cases in control group), then detected the serum GDF15 levels and laboratory indicators, and further investigated the correlation between GDF15 and laboratory indicators, and also analyzed the clinical value of GDF15 in sepsis diagnosis, severity assessment, and prognosis. In vitro, we used LPS to stimulate THP-1 and RAW264.7 cells to establish the inflammatory model, and detected the expression of GDF15 in the culture medium and cells under the inflammatory state. After that, we added GDF15 recombinant protein (rGDF15) pretreatment to explore its prospective regulatory effect on macrophage inflammation and its functions. The results showed that the serum GDF15 levels were significantly increased in the sepsis group, which was correlated with laboratory indexes of organ damage, coagulation indexes, inflammatory factors, and SOFA score. GDF15 also has a high AUC in the diagnosis of sepsis, which can be further improved by combining with other indicators. The dynamic monitoring of GDF15 levels can play an important role in the judgment and prognosis of sepsis. In the inflammatory state, the expression of intracellular and extracellular GDF15 increased. GDF15 can reduce the levels of cytokines, inhibit M1 polarization induced by LPS, and promote M2 polarization. Moreover, GDF15 also enhances the phagocytosis and bactericidal function of macrophages. Finally, we observed a decreased level of the phosphorylation of JAK1/STAT3 signaling pathway and the nuclear translocation of NF-κB p65 with the pretreatment of rGDF15. In summary, our study found that GDF15 has good clinical application value in sepsis and plays a protective role in the development of sepsis by regulating the functions of macrophages and inhibiting the activation of JAK1/STAT3 pathway and nuclear translocation of NF-κB p65.

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