Monocyte distribution width: a marker for sepsis in emergency department = Monocyte distribution width: a marker for sepsis in emergency department

다국어 초록 (Multilingual Abstract)

Background: In sepsis management, early recognition of septic patient is crucial, but the detection of sepsis often delayed due to sepsis criteria requiring much clinical information. Monocyte distribution width (MDW) is a potential early marker of sepsis which was not validated in the Korean population. Methods: A prospective cohort study was conducted to test MDW as a marker of sepsis in the emergency department (ED) of a tertiary referral hospital. Results: Total 666 adult patients presenting in ED and performed complete blood count (CBC) were enrolled from November 2018 through July 2019. They were classified as non-infection (n=170, 25.5%), infection (n=82, 12.3%), systemic inflammatory reaction syndrome (SIRS) (n=76, 11.4%), sepsis (n= 285, 42.8%), severe sepsis (n=12, 1.8%) and septic shock (n=41, 6.2%) according to SEPSIS-2 definition. MDW presented as mean ± standard deviation in non-infection (19.5 U ± 4.7), infection (22.3 U ± 5.2), SIRS (24.4 ± 9.0), sepsis (25.2 U ± 7.6), severe sepsis (29.0 U ± 12.6) and septic shock (34.5 U ± 15.1), respectively. Comparison of diagnostic accuracy of biomarkers was made by the area under the curve (AUC) of the receiver operating curve. C-reactive protein (CRP) showed best abilityto diagnose sepsis among the biomarkers (AUC 0.79, 95% confidential interval [CI] 0.75-0.83) followed by MDW (AUC, 0.71, 95% CI, 0.66-0.75), Procalcitonin (PCT) (AUC, 0.70, 95% CI, 0.66-0.75), and white blood cell count (WBC) (AUC 0.59, 95% CI, 0.54-0.64). With cutoff value 20 U, MDW diagnosed sepsis with 81.4% of sensitivity but only 52.6 % of specificity, negative predictive value was 78.2% while positive predictive value was 57.5%. Conclusions: In the emergency department, increased monocyte distribution width detected sepsis not inferior to other inflammatory markers such as procalcitonin and C-reactive protein.