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.
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.
复制标题
DOI：
10.1186/s13054-021-03622-5
复制
发表时间：
2021-06-30
期刊：
影响因子：
--
通讯作者：
Velly L
中科院分区：
文献类型：
--
作者：
Hausfater P;Robert Boter N;Morales Indiano C;Cancella de Abreu M;Marin AM;Pernet J;Quesada D;Castro I;Careaga D;Arock M;Tejidor L;Velly L
脓毒症的早期诊断已成为急诊室的主要挑战之一。脓毒症生物标志物的检测在目前的实践中被大量使用，以提高诊断的准确性。单核细胞分布宽度(MDW)是一种新的脓毒症生物标志物，可作为全血细胞计数的一部分。目的是评价MDW在急诊科(ED)检测脓毒症中的作用，并与降钙素原(PCT)和C反应蛋白(CRP)进行比较。初始评估包括完整血细胞计数的受试者在法国和西班牙的2个急诊室连续登记，并根据败血症-2和脓毒症-3标准进行分类。比较MDW与降钙素原(PCT)和C反应蛋白(CRP)检测脓毒症的效果。总共分析了1,517名患者：837名男性和680名女性，平均年龄61 ± 19岁，260名(17.1%)被归类为脓毒症-2,144名患者(9.5%)被归类为脓毒症-3。MDW和MDW合并WBC诊断脓毒症-2的AUC[95%可信区间]分别为0.81[0.78~0.84]和0.86[0.84~0.88]。对于Sepsis-3，MDW性能为0.82[0.79-0.85]。在脓毒症预试验概率较低的患者亚组中，MDW和WBC联合检测脓毒症-2的效果为0.90[0.84-0.95]。MDW联合WBC检测脓毒症的AUC与单独使用CRP相似(0.85[0.83~0.87])，超过PCT。联合使用这些生物标志物并不能改善AUC。与正常MDW相比，MDW异常使脓毒症-2和脓毒症-3的发病几率分别增加5.5倍[4.2-7.1，95%CI]和7.6[5.1-11.3，95%CI]。MDW结合WBC具有诊断脓毒症的准确性，特别是在评估试验前脓毒症概率较低的患者时。我们建议使用MDW作为系统的筛查试验，与qSOFA评分一起使用，以提高急诊科脓毒症诊断的准确性。试验注册诊所Trials.gov(NCT03588325)。网上版载有补充材料，可在10.1186/s13054-021-03622-5查阅。
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). 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). 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]. 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). The online version contains supplementary material available at 10.1186/s13054-021-03622-5.
登录
查看更多内容
DOI：
10.1001/jama.2016.0288
发表时间：
2016-02-23
期刊：
JAMA
影响因子：
--
作者：
Seymour CW;Liu VX;Iwashyna TJ;Brunkhorst FM;Rea TD;Scherag A;Rubenfeld G;Kahn JM;Shankar-Hari M;Singer M;Deutschman CS;Escobar GJ;Angus DC
通讯作者：
Angus DC
影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G
影响因子：
6.2
作者：
Hwang, Sung Yeon;Jo, Ik Joon;Shin, Tae Gun
通讯作者：
Shin, Tae Gun
影响因子：
15.1
作者：
Pierrakos, Charalampos;Velissaris, Dimitrios;Vincent, Jean-Louis
通讯作者：
Vincent, Jean-Louis
影响因子：
2.6
作者：
Leisman, Daniel E.;Angel, Catalina;Doerfler, Martin E.
通讯作者：
Doerfler, Martin E.