Abstract
Objectives
This study aims to investigate whether combining scoring systems with monocyte distribution width (MDW) improves early sepsis detection in older adults in the emergency department (ED).
Methods
In this prospective observational study, we enrolled older adults aged ≥60 years who presented with confirmed infectious diseases to the ED. Three scoring systems—namely quick sepsis-related organ failure assessment (qSOFA), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS), and biomarkers including MDW, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were assessed in the ED. Logistic regression models were used to construct sepsis prediction models.
Results
After propensity score matching, we included 522 and 2088 patients with and without sepsis in our analysis from January 1, 2020, to September 30, 2021. NEWS ≥5 and MEWS ≥3 exhibited a moderate-to-high sensitivity and a low specificity for sepsis, whereas qSOFA score ≥2 demonstrated a low sensitivity and a high specificity. When combined with biomarkers, the NEWS-based, the MEWS-based, and the qSOFA-based models exhibited improved diagnostic accuracy for sepsis detection without CRP inclusion (c-statistics=0.842, 0.842, and 0.826, respectively). Of the three models, MEWS ≥3 with white blood cell (WBC) count ≥11 × 109/L, NLR ≥8, and MDW ≥20 demonstrated the highest diagnostic accuracy in all age subgroups (c-statistics=0.886, 0.825, and 0.822 in patients aged 60–74, 75–89, and 90–109 years, respectively).
Conclusions
Our novel scoring system combining MEWS with WBC, NLR, and MDW effectively detected sepsis in older adults.
Funding source: Taipei Medical University Hospital
Award Identifier / Grant number: 108TMU-TMUH-13
Funding source: Taipei Medical University
Award Identifier / Grant number: TMU111-AE1-B07
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Research funding: This work was supported by the Taipei Medical University Hospital, Taipei, Taiwan. (Grant number: 108TMU-TMUH-13) and Taipei Medical University (Grant number: TMU111-AE1-B07).
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Author contribution: Conceptualization, S.-F.L., H.-A.L., and S.-K.H.; data curation, S.-F.L., H.-A.L., and Y.-H.P.; formal analysis, S.-F.L., H.-A.L.; funding acquisition, S.-K.H.; investigation, S.-F.L., H.-A.L., Y.-H.P., and S.-K.H.; methodology, S.-F.L.; resources, S.-K.H.; software, S.-F.L.; writing–original draft, S.-F.L., and H.-A.L.; writing–review and editing, S.-F.L., H.-A.L., and S.-K.H. All authors have read and agreed to the published version of the manuscript.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all participants.
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Ethical approval: This study was approved by the Joint Institutional Review Board of Taipei Medical University (approval number: N201904066). The research was carried out following the Declaration of Helsinki, Seventh revision by the World Medical Association.
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Data availability: The data is not publicly available and were managed by the Department of Emergency pf Medicine, Taipei Medical University, Taipei, Taiwan. With legal restrictions imposed by the government of Taiwan on the distribution of the personal health data in relation to the “Personal Information Protection Act,” requests for data need a formal proposal which should be directed to the Joint Institutional Review Board of Taipei Medical University, Taipei Taiwan (E-mail: tmujirb@gmail.com).
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2022-0656).
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