Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department

Abstract

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6-32.9) and SI (median 1.15, IQR 1.05-1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

Keywords: CBC; MDW; MMV; biomarker; monocytes; screening; sepsis.

Figure 1

Distribution of the MDW values in the subgroups investigated. In the boxplot (or box-and-whisker plot), the central box represents the values from the lower to upper quartiles (25th to 75th percentiles) or interquartile range (IQR). The middle line represents the median. Whiskers sprout from the two ends of the box up to the observations within, respectively, the lower quartile minus 1.5 times the IQR or the upper quartile plus 1.5 times the IQR. Larger observations are displayed as points and represent outliers.

Figure 2

Distribution of the Sepsis Index values in the subgroups investigated. In the boxplot (or box-and-whisker plot), the central box represents the values from the lower to upper quartiles (25th to 75th percentiles) or interquartile range (IQR). The middle line represents the median. Whiskers sprout from the two ends of the box up to the observations within, respectively, the lower quartile minus 1.5 times the IQR or the upper quartile plus 1.5 times the IQR. Larger observations are displayed as points and represent outliers.

Figure 3

ROC curve analysis for comparison of the MDW (dashed) and Sepsis Index (solid) levels in sepsis prediction. The area under the curve (AUC) represents the test accuracy. The diagonal line, with an AUC of 0.5, indicates a perfect chance.