Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department

• Published in: Journal of the American College of Emergency Physicians Open Vol. 3; no. 2; pp. e12679 - n/a
• Main Authors: Malinovska, Alexandra, Hinson, Jeremiah S., Badaki‐Makun, Oluwakemi, Hernried, Benjamin, Smith, Aria, Debraine, Arnaud, Toerper, Matthew, Rothman, Richard E., Kickler, Thomas, Levin, Scott
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-04-2022; John Wiley and Sons Inc; Wiley
• Subjects: Accuracy; Automation; Biomarkers; Blood tests; complete blood count (CBC); Electronic health records; emergency medicine; Infections; Infectious Disease; Laboratories; monocyte distribution width (MDW); Mortality; neutrophil to lymphocyte ratio (NLR); Neutrophils; Original Research; Patients; Performance evaluation; Sepsis; septic shock; triage; United States > US; septic shock; complete blood count (CBC); emergency medicine; monocyte distribution width (MDW); neutrophil to lymphocyte ratio (NLR); triage; sepsis
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.12679

Study Objective
Enhancement of a routine complete blood count (CBC) for detection of sepsis in the emergency department (ED) has pragmatic utility for early management. This study evaluated the performance of monocyte distribution width (MDW) alone and in combination with other routine CBC parameters as a screen for sepsis and septic shock in ED patients.
Methods
A prospective cohort analysis of adult patients with a CBC collected at an urban ED from January 2020 through July 2021. The performance of MDW, white blood count (WBC) count, and neutrophil‐to‐lymphocyte‐ratio (NLR) to detect sepsis and septic shock (Sepsis‐3 Criteria) was evaluated using diagnostic performance measures.
Results
The cohort included 7952 ED patients, with 180 meeting criteria for sepsis; 43 with septic shock and 137 without shock. MDW was highest for patients with septic shock (median 24.8 U, interquartile range [IQR] 22.0–28.1) and trended downward for patients with sepsis without shock (23.9 U, IQR 20.2–26.8), infection (20.4 U, IQR 18.2–23.3), then controls (18.6 U, IQR 17.1–20.4). In isolation, MDW detected sepsis and septic shock with an area under the receiver operator characteristic curve (AUC) of 0.80 (95% confidence interval [CI] 0.77–0.84) and 0.85 (95% CI 0.80–0 .91), respectively. Optimal performance was achieved in combination with WBC count and NLR for detection of sepsis (AUC 0.86, 95% CI 0.83–0.89) and septic shock (0.86, 95% CI 0.80–0.92).
Conclusion
A CBC differential panel that includes MDW demonstrated strong performance characteristics in a broad ED population suggesting pragmatic value as a rapid screen for sepsis and septic shock.