INFECTION DIAGNOSTICS :: SEPSIS
Figure 2. MDW–Monocytes Activation
that ensures the most accurate results reach the clinicians in the most efficient way pos- sible. Results from MDW biomarker studies demonstrated that test results are com- parable to those of lactate and C-reactive protein (CRP).31,32
But as part of routine CBC
testing, the MDW parameter was run in all patients whereas CRP and lactate were only run for patients with suspected sepsis. Thus, more patients received more information with lower impact to the lab. The overwhelming dysfunctional immune response to infection leading to sepsis begins long before clinical symp- toms are apparent. Having a unique biomarker that is evaluated as part of a standard test is a valuable tool to help detect patients at risk of developing sepsis.
Implementing MDW at Christus Trinity Mother Frances Health System Earlier this year, the team at Christus Trinity Mother Frances Health System in Tyler, TX implemented the MDW pa- rameter in seven locations — hospitals and standalone emergency departments — to aid in early sepsis detection knowing that strategically adding MDW to the EDs could be a game changer for sepsis out- comes. When patients enter the ED, they are a blank slate. Other than vital signs and the often-limited information provided by patients, very little is known. MDW allows every adult patient to be screened — not just those with specific sepsis symptoms — without interrupting the workflow in the lab or ED. The physician doesn’t have to be looking for sepsis, but this allows for earlier identification. In the first week of use, the Christus team used the MDW biomarker to detect early sepsis in a patient; she was treated within two hours,
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and as a result, had a hospital stay of less than two days. When sepsis is diagnosed earlier, treatments can be started sooner, which leads to better patient outcomes. And achieving better patient outcomes is really what it’s all about.
Closing thoughts Monocytes react early in infection, so MDW provides an opportunity for clini- cians to narrow differential diagnosis at the beginning of the patient encounter. Because the MDW parameter is measured as part of the CBC-Diff, it has value for identifying the possibility of sepsis in indi- viduals for whom sepsis is not immediately suspected without adding to the already too-heavy workflow of the lab. The MDW parameter is not intended as a replace- ment for the qSOFA and SIRS criteria clinical analyses, but rather as an addition to these screening parameters to improve early sepsis detection.33
Combined with
innovative approaches to treatment, the MDW biomarker helps to identify severity of infection and sepsis, which may help to reduce the mortality rate associated with sepsis. Early sepsis detection leading to early source control can literally be the difference between life and death.
“Because the MDW is available in the CBC with differential, it’s available much earlier than the other biomarkers. So MDW, in combination with other patient information, will help improve our ability to identify septic patients and improve outcomes.” ~Dr. Freimer
REFERENCES
1. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mor- tality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. 2020;395(10219):200-211.
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2. Rudd KE, Kissoon N, Limmathurotsakul D, et al. The global burden of sepsis: barriers and potential solutions. Critical Care. 2018;22(1). doi:10.1186/ s13054-018-2157-z.
3. Kumar G, Kumar N, Taneja A, et al. Nation- wide Trends of Severe Sepsis in the 21st Century (2000–2007). Chest. 2011;140(5):1223-1231. doi:10.1378/ chest.11-0352.
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http://www.cdc.gov/nchs/data/ databriefs/db62.pdf
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what-is-sepsis.html Accessed September 22, 2022.
8. Filbin MR, Lynch J, Gillingham TD, et al. Present- ing symptoms independently predict mortality in septic shock: Importance of a previously unmeasured confounder. Crit Care Med. 2018;46(10):1592-1599. doi:10.1097/CCM.0000000000003260.
9. Dunne D, McDonald R, Ratnayake R, et al. Blood cultures in acute surgical admissions. Annals of The Royal College of Surgeons of England. 2015;97(1):27- 31. doi:10.1308/003588414X14055925059110.
10. Confield LR, Black GP, Wilson BC, Lowe DJ, Theakstone AG, Baker MJ. Vibrational spectroscopic analysis of blood for diagnosis of infections and sepsis: a review of requirements for a rapid diag- nostic test. Analytical Methods. 2021;13(2):157-168. doi:10.1039/d0ay01991g.
11. Wattanapaiboon K, Banditlerdruk S, Vattanavanit V. Presenting symptoms in sepsis: Is the mnemonic “SEPSIS” useful?. Infect Drug Resist. 2020;13:2199- 2204. Published 2020 Jul 8. doi:10.2147/IDR.S263964.
12. Comstedt P, Storgaard M, Lassen AT. The Sys- temic inflammatory response syndrome (SIRS) in
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