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A7733 - Monocyte Distribution Width, A Novel Indicator, Detects Sepsis in High Risk Patients Presenting to the Emergency Department
Author Block: E. D. Crouser1, J. Parrillo2, C. W. Seymour3, D. C. Angus4, K. Bicking2, V. G. Esguerra5, R. Magari6, L. Tejidor6, D. Careaga6, M. Samoszuk6; 1Ohio State Univ, Columbus, OH, United States, 2Hackensack University Medical Center, Hackensack, NJ, United States, 3Crit Care Clini Research, University of Pittsburgh, Pittsburg, PA, United States, 4Univ of Pittsburgh School of Med, Pittsburgh, PA, United States, 5Internal Medicine, The OSU Wexner Medical Center, Columbus, OH, United States, 6Beckman Coulter, Inc., Miami, FL, United States.
Rationale: Rapid detection of sepsis is a high priority in the emergency department (ED) so as to promote earlier and more effective treatments. Monocyte volume Distribution Width (MDW) increases in response to acute infection, reflecting infection severity (CHEST; 2017;152(3):518-26.). Using a modified MDW parameter (greater size distribution range) we sought to determine the optimal cutoff values for early sepsis detection in ED patients admitted for at least 12 hours, a subpopulation at high risk for hospital admission (Medicine 2016; 95 (14):1-7.). Methods: A prospective IRB approved, blinded, observational cohort study was conducted between March and July 2017 enrolling 505 representative patients presenting to EDs at three U.S. academic centers. The study enrolled adult patients, ages 18 - 89 yrs, who had a complete blood count (CBC) with differential on admission to the ED, and who remained in the hospital (ED or inpatient) for at least 12 hours. Blood samples were analyzed on a Beckman Coulter Unicel DxH Coulter Cellular Analysis System. Determination of Sepsis-2 and Sepsis-3 based on established criteria was performed by two independent critical care experts from each site using all data available 7 days after ED admission. In the event of disagreement between internal adjudicators, a third adjudication was performed by an external consultant to finalize the diagnostic classification. Results: By Sepsis-2 criteria, 13.3% of patients were identified with sepsis [controls (n=280), SIRS (n=98), infection (n=60), or sepsis (n=67)]; and by Sepsis-3 criteria: 9.7% of patients were identified with sepsis [controls (n=378), infection (n=78), or sepsis (n=49)]. MDW effectively differentiated sepsis from all other conditions based upon either Sepsis-2 criteria [AUC 0.76 (95% CI: 0.69-0.82)] or Sepsis-3 criteria [AUC 0.78 (95% CI: 0.71-0.86)]. A MDW cutoff of 20.0 was optimal for sepsis detection based on either Sepsis-2 (sensitivity 72%, specificity 69%) or Sepsis-3 criteria (sensitivity 78%; specificity 68%), with negative predictive values (NPVs) of 94% and 97%, respectively. A MDW cutoff of ≥19.0 further improved the sensitivity for Sepsis-2 [83%; (95% CI: 71-89%)] and Sepsis-3 [82%; (95% CI: 68-90%)] with NPVs of 95% and 98%, respectively. Conclusions: This study demonstrated that a modified MDW analysis performed in association with a CBC at the time of ED admission may be useful for initial sepsis detection, either by Sepsis-2 or Sepsis-3 criteria, and that a MDW within normal limits reliably excludes the diagnosis of sepsis. These results require further validation in a larger, multi-site study that is in progress.