Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study

Abstract

Background Early sepsis diagnosis has emerged as one of the main challenges in the emergency room. Measurement of sepsis biomarkers is largely used in current practice to improve the diagnosis accuracy. Monocyte distribution width (MDW) is a recent new sepsis biomarker, available as part of the complete blood count with differential. The objective was to evaluate the performance of MDW for the detection of sepsis in the emergency department (ED) and to compare to procalcitonin (PCT) and C-reactive protein (CRP). Methods Subjects whose initial evaluation included a complete blood count were enrolled consecutively in 2 EDs in France and Spain and categorized per Sepsis-2 and Sepsis-3 criteria. The performance of MDW for sepsis detection was compared to that of procalcitonin (PCT) and C-reactive protein (CRP). Results A total of 1,517 patients were analyzed: 837 men and 680 women, mean age 61 ± 19 years, 260 (17.1%) categorized as Sepsis-2 and 144 patients (9.5%) as Sepsis-3. The AUCs [95% confidence interval] for the diagnosis of Sepsis-2 were 0.81 [0.78–0.84] and 0.86 [0.84–0.88] for MDW and MDW combined with WBC, respectively. For Sepsis-3, MDW performance was 0.82 [0.79–0.85]. The performance of MDW combined with WBC for Sepsis-2 in a subgroup of patients with low sepsis pretest probability was 0.90 [0.84–0.95]. The AUC for sepsis detection using MDW combined with WBC was similar to CRP alone (0.85 [0.83–0.87]) and exceeded that of PCT. Combining the biomarkers did not improve the AUC. Compared to normal MDW, abnormal MDW increased the odds of Sepsis-2 by factor of 5.5 [4.2–7.1, 95% CI] and Sepsis-3 by 7.6 [5.1–11.3, 95% CI]. Conclusions MDW in combination with WBC has the diagnostic accuracy to detect sepsis, particularly when assessed in patients with lower pretest sepsis probability. We suggest the use of MDW as a systematic screening test, used together with qSOFA score to improve the accuracy of sepsis diagnosis in the emergency department. Trial Registration ClinicalTrials.gov (NCT03588325).

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

“…It has been approved by the Food and Drug Administration (FDA) as a biomarker for the early detection of sepsis in ED. Recently, several authors showed that MDW has good diagnostic accuracy for early-identifying patients at high risk of developing sepsis, especially in the ED and the ICU [114][115][116][117][118][119][120][121][122][123]. MDW is characterized by a high negative predictive value for sepsis diagnosis.…”

Axial light loss of monocytes as a readily available prognostic biomarker in patients with suspected infection at the emergency department

“…Recently, there have been numerous publications on MDW in the context of sepsis [ 22 – 27 ]. However, all previous MDW studies investigated the diagnostic value of MDW for sepsis, rather than its prognostic value.…”

“…In early stages of sepsis monocytes are activated and undergo morphological changes [ 21 , 22 ] that may be useful for early identification of the disease. Recently, Monocyte Distribution Width (MDW) was suggested as an early sepsis indicator [ 22 – 27 ]. A downside to MDW as a biomarker is the requirement of a specific costly analyzer [ 22 ].…”

Advances in Immune Monitoring Approaches for Sepsis-Induced Immunosuppression

“…Monocyte distribution width (MDW) represents a significant indicator reflecting monocyte response to bloodstream pathogenic invasions. The elevation of MDW has been documented for the early identification of sepsis ( 100 – 102 ). A high MDW level can potentially predict corticosteroid resistance among patients with sepsis and septic shock ( 103 ).…”