Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis

Abstract

We carried out a prospective observational study to evaluate whether Monocyte Distribution Width (MDW) may play a role in identifying patients with sepsis in comparison with Procalcitonin (PCT). We prospectively enrolled all consecutive patients hospitalized at the Infectious Diseases Unit of Pescara General Hospital for bacterial infection or sepsis. MDW values were collected for all patients. Clinical characteristics, demographic data, past and present medical history, microbiological results, PCT, as well as neutrophil and monocytes indices at entry were compared in the 2 groups. Two-hundred-sixty patients were enrolled, 63.5% males, aged 59.1±19.5 years. Sepsis was diagnosed in 105 (40.4%); in 60 (57.1%) at least 1 microorganism was isolated from blood cultures. In multivariate models, MDW as a continuous variable (OR:1.57 for each unit increase; 95%CI: 1.31-1.87, p<0.001) and PCT>1 ng/ mL (OR: 48.5; 95%CI: 14.7-160.1, p<0.001) were independently associated with sepsis. Statistical best cut points associated with sepsis were 22.0 for MDW and 1.0 ng/mL for PCT whereas MDW values<20 were invariably associated with negative blood cultures. At ROC curve analysis, the AUC of MDW (0.87) was nearly overlapping that of PCT (0.88). Our data suggest that incorporating MDW within current routine WBC counts and indices may be of remarkable use for detection of sepsis. Further research is warranted.

Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study

“…MDW, a new biomarker for systemic inflammation, is an early indicator of sepsis [ 19 , 21 ], with excellent NPV(negative predictive value). Moreover, an MDW of <20 is correlated with advanced organ dysfunction and infection severity [ 19 , 22 – 24 ]. In a study comparing the diagnostic powers of MDW and procalcitonin levels for sepsis, the AUC of MDW (0.87) was similar to that of procalcitonin levels (0.88) [ 22 ].…”

“…Moreover, an MDW of <20 is correlated with advanced organ dysfunction and infection severity [ 19 , 22 – 24 ]. In a study comparing the diagnostic powers of MDW and procalcitonin levels for sepsis, the AUC of MDW (0.87) was similar to that of procalcitonin levels (0.88) [ 22 ]. Because MDW is a component of the complete blood cell count and differential blood count, it can be performed in EDs and outdoor epidemic prevention screening stations to aid timely decision-making.…”

Monocyte Distribution Width (MDW) as a New Tool for the Prediction of Sepsis in Critically Ill Patients: A Preliminary Investigation in an Intensive Care Unit

“…Optimal thresholds for MDW and PCT were de ned as those achieving the maximum value of Youden index. Cut-offs for ROC analysis were de ned based upon the results obtained from the maximum level above, as well as from previous literature, including a value of 20.0 for high NPV to rule out sepsis [15,16] and 22.0 as the best statistical cut-off for the prediction of sepsis [16,22]. ROC curves were produced along with their 95% con dence bands, using all possible cut-offs of MDW and PCT.…”

“…Producers of hematological analyzers do not provide any unit for MDW and other positional parameters, as previously published [18,19]. Positional parameters derive from an algorithmic application that transforms femtoliters in positions on the x-axis of the scatterplot, of entity proportionate to the value of the cell volume [16].…”

“…Monocytes are known to increase their size upon activation in bacteriemic or fungemic patients; as a consequence, measuring the spread of monocyte size in reading chambers of new generation hematologic analyzers represents a new potential tool to monitor ensuing sepsis [15]. We already showed the potential bene t of MDW evaluations to diagnose sepsis in patients admitted to an Infectious Diseases Ward [16].…”