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

Alexandra Malinovska; Jeremiah S Hinson; Oluwakemi Badaki-Makun; Benjamin Hernried; Aria Smith; Arnaud Debraine; Matthew Toerper; Richard E Rothman; Thomas Kickler; Scott Levin

doi:10.1002/emp2.12679

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

J Am Coll Emerg Physicians Open. 2022 Feb 28;3(2):e12679. doi: 10.1002/emp2.12679. eCollection 2022 Apr.

Authors

Alexandra Malinovska^{1

2}, Jeremiah S Hinson^{1

3

4}, Oluwakemi Badaki-Makun^{3

5}, Benjamin Hernried¹, Aria Smith^{1

3}, Arnaud Debraine⁴, Matthew Toerper^{1

3

4}, Richard E Rothman¹, Thomas Kickler⁶, Scott Levin^{1

3

4}

Affiliations

¹ Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA.
² Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore Maryland USA.
³ Malone Center for Engineering in Healthcare Johns Hopkins Whiting School of Engineering Baltimore Maryland USA.
⁴ StoCastic Baltimore Maryland USA.
⁵ Division of Pediatric Emergency Medicine, Department of Pediatrics Johns Hopkins University School of Medicine Baltimore Maryland USA.
⁶ Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USA.

Abstract

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.

Keywords: complete blood count (CBC); emergency medicine; monocyte distribution width (MDW); neutrophil to lymphocyte ratio (NLR); sepsis; septic shock; triage.