A new hematological parameter model for the diagnosis and prognosis of sepsis in emergency department: A single-center retrospective study.

INTRODUCTION: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. METHODS: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC-6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. RESULTS: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810-0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730-0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826-0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C-reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. CONCLUSION: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis-related mortality.

A new haematological model for the diagnosis and prognosis of severe community-acquired pneumonia: a single-center retrospective study.

Background: Severe community-acquired pneumonia (sCAP) is a condition where infection-induced lung tissue inflammation intensifies to a certain stage, resulting in organ dysfunction and even life-threatening disease. When sCAP occurs, neutrophils and monocytes will be activated and released into the peripheral blood to kill bacteria. There are significant morphological changes in these activated neutrophils and monocytes. Haematological parameters can reflect these morphological changes, and indicate the occurrence of sCAP and the severity of infection. This study is designed to establish a new haematological model and explore its clinical value in the diagnosis and prognosis of sCAP. Methods: Patients who fulfilled the diagnostic criteria of common pneumonia (CP) and sCAP were enrolled in this study. Healthy body check-up patients were also enrolled as a control group. Characteristic information and 28-day survival of patients were recorded. Haematological results, C-reactive protein (CRP) and procalcitonin (PCT) were calculated by BC-6800 Plus automated haematology analyser and cobas E601 automated biochemical immunoassay analyser. Results: A total of 100 check-ups patients, 100 CP patients, and 111 sCAP patients were enrolled in this study. The new haematological model WBC & Mon-XW, combining WBC (white blood cell count) and Mon-XW (monocytes complexity distribution width), was significantly elevated in the sCAP group and significantly higher than in the control group and the CP group. The new model had good diagnostic efficacy for sCAP, with an area under the receiver operating characteristic curve (ROC-AUC) of 0.842, which was higher than that of CRP (0.633) and PCT (0.750). Moreover, WBC & Mon-XW was effective for survival prognostic evaluations of sCAP, with an ROC-AUC of 0.748. The new model was the independent predictors for the death of pneumonia with an OR (odds ratio) value of 1.82. The 28-day mortality rate was approximately 40% in the WBC & Mon-XW ≥8.9 group, which was approximately 15% higher than that in the WBC & Mon-XW <8.9 group. Conclusions: The new haematological model can be used as an indicator for sCAP diagnosis and prognosis.

Use of fibrin monomer and D-Dimer in assessing overt and nonovert disseminated intravascular coagulation.

INTRODUCTION: Early diagnosis of disseminated intravascular coagulation (DIC) before its progression to an overt stage is beneficial for its treatment and prognosis.This retrospective study aimed to evaluate the diagnostic performance of D-dimer and fibrin monomer in the early stage of DIC.A total of 707 patients suspected of having DIC, 302 healthy people were enrolled and divided into four groups: overt DIC, nonovert DIC, non-DIC based on the International Society of Thrombosis and Hemostasis scoring for overt DIC and the modified nonovert DIC criteria, healthy people as control group. Quantitative determination was done by immunoturbidimetry for D-dimer and fibrin monomer.The median of fibrin monomer in overt, nonovert and non-DIC was 41.65, 26.89 and 8.68 µg/ml, respectively. The median of D-dimer in overt, nonovert and non-DIC was 9.69, 3.98 and 3.08 µg/ml, respectively. D-dimer and fibrin monomer values were higher in overt DIC than other groups, but there was no difference between nonovert DIC and non-DIC in D-dimer. Unlike D-dimer, statistically significant differences were found in fibrin monomer between nonovert and non-DIC. At receiver operator characteristic curve-generated cutoff values, fibrin monomer had much excellent predictive performance compared with D-dimer for distinguishing nonovert DIC from non-DIC. D-dimer and fibrin monomer had same diagnostic performance in distinguishing overt DIC from non-DIC.Fibrin monomer is a better indicator compared with D-dimer in distinguishing patients with nonovert DIC from non-DIC. Hence, it might serve as an excellent negative exclusion marker to provide a reference for early clinical diagnosis and intervention through more studies.