Diagnostic and Prognostic Utility of Monocyte Cell Population Data in Emergency Department Patients with Suspected Sepsis.

Abstract

Background Cell population data (CPD) have been suggested as useful biomarkers for sepsis. We evaluated the diagnostic and prognostic utility of monocyte CPD parameters for sepsis diagnosis in an emergency department (ED) setting. Methods In 485 patients with suspected sepsis (sepsis, N=170), 14 monocyte CPD parameters were measured using a DxH 900 analyzer (Beckman Coulter). The most effective monocyte CPD parameters were selected for diagnosing sepsis and predicting 30-day mortality. Using the ROC curve analyses, the selected CPD parameters were compared with quick sequential organ failure assessment (qSOFA) (for diagnosing sepsis) and SOFA scores (for predicting 30-day mortality). The hazard ratio (HR) for 30-day mortality prediction was derived from Kaplan-Meier survival curves. Results SD of monocyte median angle light scatter (SD-MALS-MO) and mean monocyte conductivity (MN-C-MO) were the most effective monocyte CPD parameters. SD-MALS-MO significantly enhanced the performance of qSOFA score for sepsis diagnosis [area under the curve (AUC), 0.77 vs. 0.73; P <0.009]. MN-C-MO and SD-MALS-MO combined performed comparably to SOFA score in predicting 30-day mortality (AUC, 0.70 vs. 0.75; P =0.321) but yielded a higher HR for 30-day mortality than SOFA score (HR: 7.5 vs. 5.8, P <0.001). Conclusions Monocyte CPD parameters offer additional value to qSOFA score for diagnos-ing sepsis, and their combination is as effective as SOFA score for predicting 30-day mor-tality in ED patients with suspected sepsis. Monocyte CPD parameters can be valuable di-agnostic and prognostic biomarkers for sepsis.