Scott Levin, Nima Sarani, Jeremiah Hinson, Melissa Naiman, Chad Cannon, Aria Smith, Benjamin Steinhart, Arnaud DeBraine, Sarah Kehoe, Bryan Immhoff, Yasir Taribichi, Alexandra Malinovska, Kemi Badaki-Makun
{"title":"利用单核细胞分布宽度的全血细胞计数脓毒症指数早期发现无明显症状患者的脓毒症。","authors":"Scott Levin, Nima Sarani, Jeremiah Hinson, Melissa Naiman, Chad Cannon, Aria Smith, Benjamin Steinhart, Arnaud DeBraine, Sarah Kehoe, Bryan Immhoff, Yasir Taribichi, Alexandra Malinovska, Kemi Badaki-Makun","doi":"10.1097/CCE.0000000000001194","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>The ED of the University of Kansas Medical Center, United States.</p><p><strong>Patients: </strong>All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.</p><p><strong>Interventions: </strong>MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.</p><p><strong>Measurements and main results: </strong>In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.</p><p><strong>Conclusions: </strong>The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1194"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729153/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Complete Blood Count Sepsis Index Using Monocyte Distribution Width for Early Detection of Sepsis in Patients Without Obvious Signs.\",\"authors\":\"Scott Levin, Nima Sarani, Jeremiah Hinson, Melissa Naiman, Chad Cannon, Aria Smith, Benjamin Steinhart, Arnaud DeBraine, Sarah Kehoe, Bryan Immhoff, Yasir Taribichi, Alexandra Malinovska, Kemi Badaki-Makun\",\"doi\":\"10.1097/CCE.0000000000001194\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>The ED of the University of Kansas Medical Center, United States.</p><p><strong>Patients: </strong>All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.</p><p><strong>Interventions: </strong>MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.</p><p><strong>Measurements and main results: </strong>In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.</p><p><strong>Conclusions: </strong>The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":\"7 1\",\"pages\":\"e1194\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729153/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001194\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001194","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的：利用全血细胞计数（CBC）鉴别（CBC-diff）对早期脓毒症的检测具有实用价值，特别是对那些没有明显表现的患者。本研究的目的是建立包含单核细胞分布宽度（MDW）的CBC脓毒症指数（CBC- si），以加强快速脓毒症筛查。设计：回顾性观察性研究。地点：美国堪萨斯大学医学中心急诊科。患者：2020年8月8日至2022年4月1日期间就诊于急诊科的所有成年患者（18岁或以上），作为常规临床护理的一部分接受CBC-diff检查。干预措施：MDW、WBC计数和中性粒细胞与淋巴细胞比值用于早期败血症检测CBC-SI（0低至5高风险）。评估CBC-SI对有无明显早期脓毒症症状患者的诊断性能。测量和主要结果：在51,407例ED就诊的队列中，1,683例（3.3%）符合败血症标准；脓毒症患者有明显体征1343例（79.8%），无明显体征340例（20.2%）。CBC-SI曲线下总面积为0.83 （95% CI, 0.81-0.85）。CBC-SI大于或等于1点时，敏感性为83.1% (95% CI, 799 -86.2%)，特异性为64.8% （95% CI, 64.0-65.5%）。无明显体征的患者亚组表现较好；大于或等于1点，81.1% （95% CI, 73.2-88.9%）的敏感性和69.1% （95% CI, 68.3-69.9%）的特异性。无明显体征的脓毒症患者在到达后出现抗生素给药延迟(中位数4.7 vs 3.4小时；p < 0.001)和更高的ICU入院率(43.8% vs. 27.9%；P < 0.001)和住院死亡率(14.7% vs. 9.8%；P = 0.011)，与表现明显的脓毒症亚组比较。结论：CBC-SI在早期脓毒症检测中表现出较强的性能。它的表现在不明显的表现中是最好的，这表明在最容易受到延迟干预和较差结果影响的亚组中，效用最高。
The Complete Blood Count Sepsis Index Using Monocyte Distribution Width for Early Detection of Sepsis in Patients Without Obvious Signs.
Objectives: Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.
Design: A retrospective observational study.
Setting: The ED of the University of Kansas Medical Center, United States.
Patients: All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.
Interventions: MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.
Measurements and main results: In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.
Conclusions: The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
