Photo Credit: ALIOUI Mohammed Elamine

The following is a summary of “Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study,” published in the October 2024 issue of Critical Care by Abreu et al. 

Researchers conducted a retrospective study to analyze the effect of bedside implementation of the biomarker monocyte distribution width (MDW) on time for anti-infective administration in the emergency department (ED).   

They analyzed a Paris hospital ED to compare the outcomes of patients with sepsis before and after implementing point-of-care (POC) MDW measurement. In period 2, ED nurses measured MDW with complete blood count results in 2 minutes. For MDW >21.5 units, ED physicians were asked to consider sepsis and start anti-infectives promptly. The primary endpoint was time to anti-infectious administration (TTA) from ED arrival, with secondary endpoints including TTA from sepsis onset (TTAS), length of stay, mortality, and hospitalization rates.  

The results showed that 255 patients (period-1) and 180 patients (period-2) with sepsis were included. The TTA was 5.4 hours (3.5–7.7) in period-1 and 4.9 hours range (IQR 2.5–7.1) in period-2 (P = 0.06). Implementation of MDW significantly reduced the median time to TTAS from 3.7 hours (IQR 1.5–5.8) in period-1 to 2.2 hours (IQR 0.5–4.5) in period-2 (P < 0.001). Mortality rates were similar between periods (18% vs 16%, P = 0.4), as were hospitalization rates (93% vs 91%, P = 0.4) and ED length of stay (7.2 hours [5.3–9.8] vs 7.0 hours [5.4–9.4], P = 0.7).  

They concluded that implementing POC MDW measurement in ED protocols enhanced the timeliness of anti-infective administration from sepsis commencement, aligning with current sepsis management guidelines. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05141-5