A-139 Early Sepsis Screening in Patients with Suspected Sepsis in Emergency Settings: a Sequential Strategy of Monocyte Distribution Width and Presepsin

Abstract Background Monocyte distribution width (MDW), an US FDA-cleared early sepsis indicator, is intended for use with adults patients presenting to the emergency departments (ED). We evaluated the clinical utility of a sequential measurement of MDW and presepsin (a soluble CD14-subtype) for the early sepsis screening in the ED. Methods In a total of 281 patients with suspected sepsis, 128 patients (45.6%) were diagnosed as having sepsis based on the Sepsis-3 criteria. Using EDTA-K3 whole blood samples, MDW was measured in the Beckman Coulter DxH 900 analyzer, and presepsin level was measured in the Sysmex HISCL system, with a respective cut-off of 21.5 and 500 pg/mL. MDW, presepsin, and sequential strategies (MDW followed by presepsin) were compared using area under the curves (AUC) of receiver operating characteristic (ROC) curve analyses, diagnostic tests, and Chi-squared tests. Results MDW, presepsin, and the sequential strategy were comparable for diagnosing sepsis (AUCs: 0.52 vs. 0.65 vs. 0.52). The sequential strategy increased sensitivity to 98.4%, compared with MDW and presepsin (sensitivities of 90.6% and 89.8%, respectively). The sequential strategy significantly reduced false negative results compared with MDW and presepsin (two [1.6%] for the sequential strategy vs. 12 [9.4%] for MDW vs. 13 [10.2%] for presepsin, P < 0.001). Conclusion Compared with individual measurement of MDW and presepsin, the sequential strategy of MDW followed by presepsin would improve early sepsis screening in ED patients with significantly reducing false negatives. This strategic approach promises more timely and accurate sepsis screening, potentially improving patient outcomes.