Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department

Abstract

Background Monocyte Distribution Width (MDW), a simple cellular marker of innate monocyte activation, can be used for the early recognition of sepsis. We performed an observational prospective monocentric study to assess the predictive role of MDW in detecting sepsis in a sample of consecutive patients presenting at the Emergency Department. Methods Prospective observational study using demographic and clinical characteristics, past medical history and other laboratory measurements to predict confirmed sepsis using multivariate logistic regression. Results A total of 2724 patients were included in the study, of which 272 (10%) had sepsis or septic shock. After adjusting for known and potential risk factors, logistic regression found the following independent predictors of sepsis: SIRS equal to 1 (OR: 2.32, 1.16–4.89) and 2 or more (OR: 27.8, 14.8–56.4), MDW > 22 (OR: 3.73, 2.46–5.70), smoking (OR: 3.0, 1.22–7.31), end stage renal function (OR: 2.3, 1.25–4.22), neurodegenerative disease (OR: 2.2, 1.31–3.68), Neutrophils ≥ 8.9 × 103/µL (OR: 2.73, 1.82–4.11), Lymphocytes < 1.3 × 103/µL (OR: 1.72, 1.17–2.53) and CRP ≥ 19.1 mg/L (OR: 2.57, 1.63–4.08). A risk score derived from predictive models achieved high accuracy by using an optimal threshold (AUC: 95%; 93–97%). Conclusions The study suggests that incorporating MDW in the clinical decision process may improve the early identification of sepsis, with minimal additional effort on the standard procedures adopted during emergency care.

Understanding the value of monocyte distribution width (MDW) in acutely ill medical patients presenting to the emergency department: a prospective single center evaluation

“…Those findings are consistent with the previous reports 4 – 14 . The cut-off value 22 for sepsis prediction, as determined in our study, was similar to that reported by Jo et al 6 , Polili et al 13 , 17 and Hausfater et al 19 , yet slightly higher than values obtained in other studies 4 , 5 , 7 , 10 – 12 , 14 – 17 , 19 . This could be explained by the type of anticoagulant used for blood samples.…”