Monocyte distribution width (MDW) as a screening tool for early detecting sepsis: a systematic review and meta-analysis

Agnello, Luisa; Vidali, Matteo; Sasso, Bruna Lo; Giglio, Rosaria Vincenza; Gambino, Caterina Maria; Scazzone, Concetta; Ciaccio, Anna Maria; Bivona, Giulia; Ciaccio, Marcello

doi:10.1515/cclm-2021-1331

Cited by 27 publications

(19 citation statements)

References 28 publications

(20 reference statements)

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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%

“…Researches had linked MDW index to both COVID-19 and Sepsis [11], as well as studies have associated Sepsis and COVID-19 to histone levels [6,15]; curiously, no data are currently available on histones as MDW modifiers. These bases raised the possibility that histones may contribute to the activation and morphological dysregulation of monocytes in both COVID-19 and Sepsis infections [4,16].…”

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%

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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“…However, the SOFA score can take time to obtain; thus, SIRS criteria [abnormal white blood cell count (WBC), tachycardia, tachypnea, and fever (or hypothermia)] and quick sepsis-related organ failure assessment (qSOFA) score (tachypnea, altered mental state, and hypotension) are used as surrogate methods to assist in the quick diagnosis of sepsis in the ED. Crouser et al 33 found that regardless of SIRS or qSOFA variables, an initial MDW >20.0% (vs. <20.0) significantly increased the incidence of sepsis; Meanwhile, according to Agnello et al 34 meta-analysis data, MDW plays an important role in Sepsis screening regardless of the Sepsis-2 and Sepsis-3 standard groups; therefore, MDW improved the early detection of sepsis in the initial ED and was a good complement to SIRS and qSOFA parameters. Similarly, the combination of MDW and white blood cell count (WBC), 35 neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) 36 significantly improved the early diagnosis of sepsis.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Wu¹,

Li²,

Luo³

2022

JIR

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Monocyte distribution width (MDW) is a blood monocyte morphological parameter that can be easily detected by an automated hemocyte analyzer and can provide clinicians with important information about cell volume variability in peripheral blood monocyte populations. The United States’ Food and Drug Administration and Conformite Europeenne have both been cleared for their clinical application in the detection of sepsis and developing sepsis in adult patients in the emergency department (ED). Recently, MDW has been found to have an early diagnosis and predictive value for sepsis in neonates and COVID-19 patients. Here, we summarize the findings of the studies investigating the clinical application of MDW in sepsis. Under different stimuli, especially in infectious diseases, the activation of innate immunity is the host’s first defense mechanism, and the change in monocyte volume is considered an early indicator reflecting the state of activation of innate immunity. Pivotal study data from a large multicenter patient cohort showed that abnormal MDW at presentation increases the odds of sepsis, considering the combination of MDW and White Blood Cell Count (WBC) as part of a standard sepsis assessment protocol for ED, which may increase the sensitivity and specificity of sepsis diagnosis. Meanwhile, MDW shares a diagnostic performance comparable to that of conventional biomarkers (C-reactive protein and procalcitonin) in sepsis. In addition, some evidence suggests that increased MDW, both in adults and neonates, may be associated with unfavorable short- and long-term outcomes, which indicates its prognostic value in sepsis. Taken together, MDW is a parameter of increased morphological variability of monocytes in response to infection, and numerous studies have shown that MDW could be used as a valuable diagnostic and prognostic index in patients with sepsis or suspected sepsis.

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“…[ 13 ] After infectious stimuli, monocytes undergo activation leading to functional and morphological changes. [ 14 ] Presepsin, a 13-kDa protein and a fragment of monocyte LPS receptor CD14, is released in the blood circulation by proinflammatory signals during infection and has diagnostic and prognostic values in sepsis. [ 15 , 16 ] Here, we explored the usefulness of MDW and presepsin for early assessment of disease severity in COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of monocyte distribution width and presepsin for early assessment of disease severity in COVID-19 patients

Kim

Lee

et al. 2022

Medicine

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Early predictors of severe coronavirus disease 2019 (COVID-19) would identify patients requiring intensive care. Recently, the monocyte distribution width (MDW) and presepsin level have been used for the early diagnosis of sepsis. Here, we assessed the utility of MDW and presepsin for the early assessment of COVID-19 severity.Eighty-seven inpatients with confirmed COVID-19 were enrolled and divided into 3 groups by the type of respiratory support: (1) mechanical ventilation or high-flow nasal cannula oxygen therapy (MVHF-OT), (2) conventional oxygen therapy, and (3) no oxygen therapy. We measured the complete blood count; MDW; erythrocyte sedimentation rate; and the levels of presepsin, C-reactive protein, procalcitonin, lactate dehydrogenase, ferritin, Krebs von den Lungen-6 (KL-6), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibody.Thirteen (14.9%) patients on MVHF-OT exhibited a significantly higher mortality and a longer hospital stay than did the others. The MDW and presepsin levels were significantly elevated on admission, and correlated with COVID-19 severity (both P < .001). Notably, only the MDW correlated significantly with symptoms in the no oxygen therapy group (P < .012). In the first week after admission, the MDW fell and no longer differed among the groups. The KL-6 level did not differ by disease severity at any time. Neutralizing antibodies were detected in 74 patients (91.4%) and the level of neutralization correlated significantly with COVID-19 severity (P < .001).The MDW and presepsin are useful indicators for early assessment of disease severity in COVID-19 patients.

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Monocyte distribution width (MDW) as a screening tool for early detecting sepsis: a systematic review and meta-analysis

Cited by 27 publications

References 28 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

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Usefulness of monocyte distribution width and presepsin for early assessment of disease severity in COVID-19 patients

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