Monocyte Distribution Width Predicts Sepsis, Respiratory Failure, and Death in COVID-19

Abstract

IntroductionSepsis is the leading cause of hospital mortality nationwide. Early recognition has been shown to improve outcomes. This research investigates the use of monocyte distribution width's (MDW) ability to detect sepsis and clinically correlate to outcomes in COVID-19 infection. MethodsThis is a retrospective, single-center cohort study of adult patients with confirmed COVID-19 requiring hospital admission over a 14-month period (September 2020 to November 2021). MDW was evaluated as a cytomarker to predict disease severity, mortality, and determination of sepsis in patients with COVID-19. Additionally, MDW was compared to existing inflammatory markers, including procalcitonin, D-dimer, ferritin, and lactic acid. ResultsMDW was able to predict sepsis in patients with COVID-19. The average MDW was found to be significantly higher in the detection of sepsis (25.50 ± 5.93) vs. patients without (23.13 ± 4.46) (p < 0.01). MDW was able to correlate with clinical outcomes or respiratory failure/hypoxia and death. An MDW value of 24.9 was shown to be the best cut-off value in determining fatal outcomes; receiver operating characteristic curve analysis revealed an area under the curve value of 0.69 (95% CI: 0.55-0.71) with a sensitivity of 83% and specificity of 71%. A chi-square test was performed, which detected a significant association between MDW values and the final clinical outcome of COVID-19 (OR = 3.52, 95% CI: 1.78-7.11, p < 0.001). Additionally, the mean MDW of patients with hypoxia or respiratory failure was significantly higher (22 vs. 25, p < 0.1). MDW did not correlate with any of the existing inflammatory markers. ConclusionMDW is a novel and reliable cytomarker for identifying sepsis in patients with COVID-19 infection. High MDW values are associated with clinical outcomes of respiratory failure and death with a mortality rate or absolute risk of 25%. MDW is easily obtained from routine laboratory evaluation in the emergency room and has the potential to be a useful tool in the triage of COVID-19 patients.