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Challenges of Identifying Sepsis
Costly
$24
billion healthcare-related costs to manage sepsisannually in the U.S.2
Difficult to Diagnose
Over 30%
of septic shock patients present with vague symptoms andmay be missed by the EMR alerts3
Sepsis Detection Using Monocyte Distribution Width
Monocyte Distribution Width (MDW) is a measure of increased morphological variability of monocytes in response to bacterial, viral or fungal infections. The quantitative analysis of MDW has received regulatory clearances as an aid for early detection in adult patients with or developing sepsis in emergency departments.
Considered with other signs and symptoms, the value of MDW helps differentiate sepsis from non-septic presentations, including non-infectious systemic inflammatory response.4 This sepsis marker is automatically reported with the complete blood count (CBC) with differential* for adult emergency department patients, without any additional test ordering.
Novel Sepsis Biomarker in the Emergency Department
Increased Sensitivity
Sensitivity of technologies is critical. When considered alone, the discriminating power of MDW is similar to that of White Blood-cell Count (WBC).
However, when MDW is considered together with WBC, MDW may add to the sensitivity and specificity of sepsis detection, as part of the standard assessment protocol in the emergency department.4,5
The Challenge of Low Symptom Presentation
Diagnostic uncertainty is a major challenge for patients presenting to the emergency department with a low number of signs and symptoms.
- 60% of emergency department patients who were diagnosed with sepsis in a pivotal study presented with zero or one symptom used for sepsis screening
- Abnormal MDW was present in up to 70% of septic "gray zone" patients4,5
MDW Modulates the Probability of Sepsis
Considered with other parameters, abnormal MDW at presentation increases the odds of sepsis.
The study determined that, when considered along with the standard physiologic parameters at the time of patient presentation, abnormal values of MDW signify a 4-6x increase in probability of sepsis diagnosis. In patients with a low level of symptoms and highest diagnostic uncertainty at presentation, abnormal MDW increased the odds of sepsis by ~3x.6
Latest Scientific Presentations
Hosted by the Compass Group, hear Dr. Crouser review sepsis epidemiology, definitions and implications and introduce a new sepsis biomarker, MDW. Additionally, hear Nan West share a septic patient case study of diagnostic challenges and explain the role of MDW. Watch recording ›
Watch the latest ACEP20 recording where Dr. Osborn and Dr. Hausfater review the current state of clinical evidence for MDW derived from the series of multicenter studies and discuss the practical implications of these results to the U.S. and European standards of sepsis care. Watch recording ›
View the webinar, hosted by Sepsis Alliance, to hear Angela D. Craig, APN, M.S., CCNS from Cookeville Regional Medical Center and Dustin Pierce, RN, BSN, CPHQ from University of Kansas Hospital discuss standards of sepsis care, review challenges with protocols and examine the clinical evidence and utility of MDW. Watch recording ›
During this webinar hosted by 360Dx, Dr. Osborn and Dr. Farnsworth review teamwork opportunities between the lab and clinical medicine for early identification of sepsis and discuss the challenges associated with current screening biomarkers and opportunities presented by MDW. Watch recording ›
The value of MDW is that it provides physicians with an earlier indication of sepsis during the initial encounter, which is especially important when a patient’s symptoms are mild and alternative diagnosis are being considered.
Ohio State University Wexler Medical Center
Resources on Sepsis Progression and Detection
- Multicenter study validates MDW as a novel marker for Sepsis-2 and Sepsis-3 in high-risk emergency department patients
- White paper reviews the role of monocytes in the progression of sepsis
- BARDA funding to develop a next-generation analytic algorithm to predict and detect sepsis earlier
Additional Resources
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*Using Early Sepsis Indicator application on Beckman Coulter DxH 900 and DxH 690T analyzers. Activation is required.
3Filbin, M. R., Lynch, J., Gillingham, T. D., Thorsen, J. E., Pasakarnis, C. L., Nepal, S., et al. Presenting Symptoms Independently Predict Mortality in Septic Shock. Critical Care Medicine, 2018; 46(10), 1592-1599. https://doi.org/10.1097/ccm.0000000000003260.
4UniCel DxH 900 Coulter Cellular Analysis System Early Sepsis Indicator (ESId) Application AddendumPN C42014AA.
5Sepsis Pivotal Repository PN C54726 Rev. AB located in CPDM.
6Crouser, E. D., Parrillo, J. E., Martin, G. S., Huang, D. T., Hausfater, P., Grigorov, I., Careaga, D., Osborn, T., Hasan, M, Tejidor, L. Monocyte Distribution Width Enhances Early Sepsis Detection in the Emergency Department Beyond SIRS and qSOFA. Journal of Intensive Care, 2020; 8(1). https://doi.org/10.1186/s40560-020-00446-3.
