The role of Monocyte Distribution Width (MDW) in the prognosis and monitoring of COVID-19 patients

Lorubbio, Maria; Tacconi, Danilo; Iannelli, Giovanni; Feri, Marco; Scala, Raffaele; Montemerani, Sara; Mandò, Massimo; Ognibene, Agostino

doi:10.1016/j.clinbiochem.2022.02.007

Cited by 24 publications

(13 citation statements)

References 11 publications

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“…MDW has been used as a marker for the early detection of sepsis and a predictor of prognosis [4,5]. It is also raised in SARS-CoV-2 infection and is associated with poor outcomes [10].…”

Section: Discussionmentioning

confidence: 99%

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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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“…MDW has been used as a marker for the early detection of sepsis and a predictor of prognosis [4,5]. It is also raised in SARS-CoV-2 infection and is associated with poor outcomes [10].…”

Section: Discussionmentioning

confidence: 99%

“…A MDW value ≥ 20.1 was helpful to detect SARS-CoV-2 infection in con rmed COVID-19 patients [8] and a higher value (MDW 28.8) was associated with ICU admission [9]. The difference between rst and last MDW less than 1 correlated with unfavorable outcomes [10].…”

Section: Introductionmentioning

confidence: 99%

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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“…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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“…Few studies have focused on the e cacy of the MDW in diagnosing diseases other than sepsis. To our knowledge, the MDW has been used for the detection of the novel coronavirus disease (COVID-19) [10][11][12] and pancreatitis [13]. However, there is a lack of evidence on the e cacy of the MDW in early prediction of the severity of other diseases.…”

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confidence: 99%

Utility of Monocyte Distribution Width for Diagnosing Colonic Diverticulitis in the Emergency Department

Chang

Hsu²,

et al. 2022

Preprint

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BackgroundColonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis.MethodsThis single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher’s exact test. The Mann–Whitney U test was used for continuous variables. Multivariate regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases.ResultsOf the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784–0.956); CRP, 0.800 (95% CI, 0.707–0.892); NLR, 0.724 (95% CI, 0.616–0.832); PLR, 0.662 (95% CI, 0.525–0.798); and WBC, 0.679 (95% CI, 0.563–0.795). The MDW had the largest AUC for diagnosing complicated diverticulitis; when the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively.ConclusionsPatients with complicated diverticulitis were significantly older and predominantly had left-sided colonic diverticulitis. A large MDW was a significant and independent predictor of complicated diverticulitis. The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.

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The role of Monocyte Distribution Width (MDW) in the prognosis and monitoring of COVID-19 patients

Cited by 24 publications

References 11 publications

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

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

Utility of Monocyte Distribution Width for Diagnosing Colonic Diverticulitis in the Emergency Department

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