Early Sepsis Detection in Adult Patients with Suspected Sepsis in an Emergency Setting: A Sequential Strategy of Monocyte Distribution Width and Presepsin

<b>Background/Objectives</b>: Monocyte distribution width (MDW) is a US FDA-cleared early sepsis indicator for adult patients presenting to the emergency department (ED). Presepsin, a soluble CD14 subtype, is another sepsis biomarker reflecting innate immune activation. We explored the clinical utility of sequential MDW and presepsin testing for early sepsis detection in the ED. <b>Methods</b>: In a total of 281 adult ED patients with suspected sepsis (including 128 patients with confirmed sepsis), MDW was measured on a DxH 900 analyzer (Beckman Coulter, USA), and presepsin level was measured using the HISCL Presepsin assay (Sysmex, Japan). Diagnostic performances of MDW, presepsin, and their combination (MDW followed by presepsin) were compared using sensitivity, specificity, and area under the curves (AUC) of receiver operating characteristic (ROC) curve analyses. <b>Results</b>: MDW, presepsin, and their combination were comparable for diagnosing sepsis (AUC ranges: 0.52-0.65). Compared with MDW and presepsin, their combination increased diagnostic sensitivity (90.6%, 89.8%, and 98.4%, respectively). Moreover, the sequential strategy significantly reduced false-negative results compared to each biomarker (2 [1.6%] for the sequential strategy vs. 12 [9.4%] for MDW vs. 13 [10.2%] for presepsin, <i>p</i> < 0.001). <b>Conclusions</b>: Compared with individual measurement of MDW and presepsin, the sequential strategy of MDW followed by presepsin would improve early sepsis detection in ED patients by significantly reducing false negatives. This approach would ensure timely and effective triage for ruling in septic patients, potentially leading to improved patient outcomes.