Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department.
Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department.
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DOI：
10.1002/emp2.12679
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发表时间：
2022-04
影响因子：
2.3
通讯作者：
Levin S
中科院分区：
文献类型：
--
作者：
Malinovska A;Hinson JS;Badaki-Makun O;Hernried B;Smith A;Debraine A;Toerper M;Rothman RE;Kickler T;Levin S
在急诊科（艾德）加强常规全血细胞计数（CBC）检测脓毒症对早期管理具有实用价值。本研究评价了单核细胞分布宽度（MDW）单独和与其他常规CBC参数联合作为艾德患者脓毒症和脓毒性休克筛查的性能。对2020年1月至2021年7月在城市艾德收集的CBC成人患者进行的前瞻性队列分析。使用诊断性能指标评价了MDW、白色血细胞计数（WBC）计数和中性粒细胞/淋巴细胞比值（NLR）检测脓毒症和脓毒性休克（脓毒症3级标准）的性能。该队列包括7952例艾德患者，其中180例符合脓毒症标准; 43例有脓毒性休克，137例无休克。感染性休克患者的MDW最高（中位数24.8 U，四分位距[IQR] 22.0-28.1），无休克的脓毒症患者MDW呈下降趋势（23.9 U，IQR 20.2-26.8），感染患者MDW呈下降趋势（20.4 U，IQR 18.2-23.3），然后是对照组（18.6 U，IQR 17.1-20.4）。单独地，MDW检测到脓毒症和脓毒性休克，其受试者操作特征曲线下面积（AUC）分别为0.80（95%置信区间[CI] 0.77-0.84）和0.85（95% CI 0.80- 0.91）。联合WBC计数和NLR检测脓毒症（AUC 0.86，95% CI 0.83-0.89）和脓毒性休克（0.86，95% CI 0.80-0.92）的性能最佳。包括MDW在内的CBC分类组在广泛的艾德人群中表现出强大的性能特征，表明其作为脓毒症和脓毒性休克的快速筛查的实用价值。
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. 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. 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). 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.
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影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G
影响因子：
8.8
作者：
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作者：
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DOI：
10.1164/rccm.201609-1848oc
发表时间：
2017-10-01
影响因子：
24.7
作者：
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通讯作者：
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影响因子：
6.2
作者：
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通讯作者：
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