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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