Monocyte Distribution Width As A Novel Sepsis Indicator in COVID-19 Patients

Alsuwaidi, Laila; Heialy, Saba Al; Shaikh, Nahid; Najjar, Firas Al; Seliem, Rania M.; Han, Aaron; Hachim, Mahmood Y.

doi:10.21203/rs.3.rs-690608/v1

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…We further compared these in vitro modifications to those measured in COVID-19 and Sepsis patients. The cut-offs reported for both MDW index and histone values are in agreement with literature references (healthy control subjects [5,6,11,12,15]; COVID-19 patients [12,14,15]; and Sepsis patients [5,6,11]).…”

Section: Introductionsupporting

confidence: 89%

“…Among common laboratory biomarkers shared by SARS-CoV-2 and Sepsis infections [7,11], the modification of the hematological parameter Monocyte Distribution Width (MDW) predicts both multiorgan failure and increased mortality rate in Sepsis conditions [11]. MDW index (FDA-approved, EC-marked early Sepsis indicator of monocyte heterogeneity upon massive inflammatory activation [11]) is further recognized as diagnostic/prognostic marker for COVID-19 severity and clinical outcomes, as a kind of novel viral Sepsis biomarker [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis

et al. 2022

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Objective Histone proteins are physiologically involved in DNA packaging and gene regulation but are extracellularly released by neutrophil/monocyte extracellular traps and mediate thrombo-inflammatory pathways, associated to the severity of many human pathologies, including bacterial/fungal sepsis and COVID-19. Prominent and promising laboratory features in classic and viral sepsis emphasize monocyte distribution width (MDW), due to its ability to distinguish and stratify patients at higher risk of critical conditions or death. No data are available on the roles of histones as MDW modifiers. Design Comparison of MDW index was undertaken by routine hematology analyzer on whole blood samples from patients with COVID-19 and Sepsis. The impact of histones on the MDW characteristics was assessed by the in vitro time-dependent treatment of healthy control whole blood with histones and histones plus lipopolysaccharide to simulate viral and classical sepsis, respectively. Measurements and main results We demonstrated the breadth of early, persistent, and significant increase of MDW index in whole blood from healthy subject treated in vitro with histones, highlighting changes similar to those found in vivo in classic and viral sepsis patients. These findings are mechanistically associated with the histone-induced modifications of cell volume, cytoplasmic granularity and vacuolization, and nuclear structure alterations of the circulating monocyte population. Conclusions Histones may contribute to the pronounced and persistent monocyte alterations observed in both acute classical and viral sepsis. Assessment of the biological impact of circulating histone released during COVID-19 and sepsis on these blood cells should be considered as key factor modulating both thrombosis and inflammatory processes, as well as the importance of neutralization of their cytotoxic and procoagulant activities by several commercially available drugs (e.g., heparins and heparinoids).

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Section: Introductionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis

et al. 2022

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“…Riva et al reported a signi cant positive correlation between MDW and in ammatory markers such as CRP, brinogen, and ferritin in COVID-19 patients[6]. Alsuwadi revealed that high MDW value (> 24.6) had a strong correlation with poor prognosis COVID-19 biomarkers[7]. Similar to previous studies, CRP was elevated in patients with SARS-CoV-2 infection and statistically signi cant higher in the respiratory support group.…”

supporting

confidence: 68%

Performance of monocyte distribution width in predicting the need for respiratory support in COVID-19 patients

Daorattanachai

Hirunrut

Pirompanich

et al. 2022

Preprint

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Background: The emergence of the novel coronavirus caused by SARS-CoV-2 infection resulted in a global pandemic whose clinical features ranged from asymptomatic infection to a severe fulminant respiratory distress and death. The monocyte distribution width (MDW) is a novel inflammatory biomarker that reflects morphological changes in response to inflammation and has been shown to useful in identifying COVID-19 identification and predicting death. There are limited data on the use of MDW for predicting the need for respiratory support. The aim of the study was to determine the performance of MDW in predicting the need for respiratory support in patients with SAR-CoV-2 infection. Methods: Our retrospective cohort study was conducted at Thammasat University hospital, Thailand. Hospitalized COVID-19 adult patients were enrolled. Respiratory support was any one of oxygen therapy, high flow nasal cannula, non-invasive or invasive mechanical ventilation. The performance of MDW was measured using the area under the receiver operating characteristic (AuROC) curve and multivariable logistic regression analysis evaluated the independent effect of MDW on respiratory support. Results: Of the 250 enrolled patients, 122 (48.8%) patients were received respiratory support. The mean MDW was significantly higher in respiratory support group: 27.2±4.6 vs 23.6±4.1 (p<0.001). An MDW≥25 alone had the best AuROC characteristics: 0.70 [95% confidence interval (CI); 0.65-0.76] for a sensitivity, specificity, and positive likelihood ratio of 71.9%, 68.2%, and 2.26, respectively. Combining age, respiratory rate and oxygen saturation increased the AUROC to 0.84 (95% CI; 0.79-0.88). Increasing age [adjusted odds ratio (aOR) 1.03], respiratory rate (aOR 1.11) and MDW≥25 (aOR 3.42) significantly increased the odds of needing respiratory support whilst a higher oxygen saturation significantly reduced it (aOR 0.81). Conclusion: MDW is a promising biomarker for predicting the need of respiratory support in COVID-19 patients and can easily be implemented in routine clinical practice.

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“…The value of MDW as a diagnostic tool has been investigated in sepsis and coronavirus disease (COVID-19). [1][2][3][4][5][6][7][8][9][10][11] Increased MDW values are associated with both disorders; however, the mechanistic processes that underpin these observations remain less clearly defined.…”

Section: Introductionmentioning

confidence: 99%

“…Monocyte distribution width (MDW) is a parameter generated alongside full blood counts (FBC) in new generation haematology analysers. The value of MDW as a diagnostic tool has been investigated in sepsis and coronavirus disease (COVID‐19) 1–11 . Increased MDW values are associated with both disorders; however, the mechanistic processes that underpin these observations remain less clearly defined.…”

Section: Introductionmentioning

confidence: 99%

Increased monocyte distribution width in COVID‐19 and sepsis arises from a complex interplay of altered monocyte cellular size and subset frequency

Cusinato

Hadcocks

Yona

et al. 2022

Int J Lab Hematology

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Introduction: Monocyte distribution width (MDW), a parameter generated alongside full blood counts (FBC) in new-generation haematology analysers, has been proposed as a diagnostic test for severe infection/sepsis. It represents the standard deviation (SD) of the monocyte mean volume (MMV). Methods: This study aimed to compare monocyte volumetric parameters retrieved by the UniCel DxH 900 haematology analyser (MMV and MDW) against corresponding parameters from the same sample measured using flow cytometry (forward scatter [FSC] mean and SD) in combination with phenotypic characterization of monocyte subtypes. We analysed blood samples from healthy individuals (n = 11) and patients with conditions associated with elevated MDW: sepsis (n = 26) and COVID-19 (n = 15). Results: Between-instrument comparisons of monocyte volume parameters (MMV vs. FSC-mean) showed relatively good levels of correlation, but comparisons across volume variability parameters (MDW vs. FSC-SD) were poor. Stratification on sample type revealed this lack of correlation only within the sepsis group. Flow cytometry analysis revealed that in healthy controls intermediate monocytes are the largest and non-classical the smallest cells. In each disease state, however, each monocyte subset undergoes different changes in volume and frequency that together determine the overall configuration of the monocyte population. Increased MDW was associated with reduced classical monocyte frequency and increased intermediate monocyte size. In COVID-19, the range of monocyte sizes (smallest to largest) reduced, whereas in sepsis it increased. Conclusion: Increased MDW in COVID-19 and sepsis has no single flow cytometric phenotypic correlate. It represents-within a single value-the delicate equipoise between monocyte subset frequency and size.

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Monocyte Distribution Width As A Novel Sepsis Indicator in COVID-19 Patients

Cited by 3 publications

References 22 publications

Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis

Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis

Performance of monocyte distribution width in predicting the need for respiratory support in COVID-19 patients

Increased monocyte distribution width in COVID‐19 and sepsis arises from a complex interplay of altered monocyte cellular size and subset frequency

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