Comparison of the diagnostic accuracy of monocyte distribution width and procalcitonin in sepsis cases in the emergency department: a prospective cohort study

Abstract

Background Early diagnosis and treatment of patients with sepsis reduce mortality significantly. In terms of exploring new diagnostic tools of sepsis, monocyte distribution width (MDW), as part of the white blood cell (WBC) differential count, was first reported in 2017. MDW greater than 20 and abnormal WBC count together provided a satisfactory accuracy and was proposed as a novel diagnostic tool of sepsis. This study aimed to compare MDW and procalcitonin (PCT)’s diagnostic accuracy on sepsis in the emergency department. Methods This was a single-center prospective cohort study. Laboratory examinations including complete blood cell and differentiation count (CBC/DC), MDW, PCT were obtained while arriving at the ED. We divided patients into non-infection, infection without systemic inflammatory response syndrome (SIRS), infection with SIRS, and sepsis-3 groups. This study’s primary outcome is the sensitivity and specificity of MDW, PCT, and MDW + WBC in differentiating septic and non-septic patients. In addition, the cut-off value for MDW was established to maximize sensitivity at an optimal level of specificity. Results From May 2019 to September 2020, 402 patients were enrolled for data analysis. Patient number in each group was: non-infection 64 (15.9%), infection without SIRS 82 (20.4%), infection with SIRS 202 (50.2%), sepsis-3 15 (7.6%). The AUC of MDW, PCT, and MDW + WBC to predict infection with SIRS was 0.753, 0.704, and 0.784, respectively (p < 0.01). The sensitivity, specificity, PPV, and NPV of MDW using 20 as the cutoff were 86.4%, 54.2%, 76.4%, and 70%, compared to 32.9%, 88%, 82.5%, and 43.4% using 0.5 ng/mL as the PCT cutoff value. On combing MDW and WBC count, the sensitivity and NPV further increased to 93.4% and 80.3%, respectively. In terms of predicting sepsis-3, the AUC of MDW, PCT, and MDW + WBC was 0.72, 0.73, and 0.70, respectively. MDW, using 20 as cutoff, exhibited sensitivity, specificity, PPV, and NPV of 90.6%, 37.1%, 18.7%, and 96.1%, respectively, compared to 49.1%, 78.6%, 26.8%, and 90.6% when 0.5 ng/mL PCT was used as cutoff. Conclusions In conclusion, MDW is a more sensitive biomarker than PCT in predicting infection-related SIRS and sepsis-3 in the ED. MDW < 20 shows a higher NPV to exclude sepsis-3. Combining MDW and WBC count further improves the accuracy in predicting infection with SIRS but not sepsis-3. Trial registration The study was retrospectively registered to the ClinicalTrial.gov (NCT04322942) on March 26th, 2020.

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

“…The MDW is a parameter that describes the size distribution of circulating monocytes. Several studies have reported that the MDW can be used for the early diagnosis of sepsis in the ED [7,8,32,33]. Similarly, Şenlikci et al found that the MDW can be used to differentiate mild pancreatitis from nonmild pancreatitis [13].…”

Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department

“…Few studies have investigated the potential association between MDW and sepsis using multivariate adjustment [35][36][37]. Recent papers focused on improving sepsis prediction through the combined use of MDW and other laboratory parameters.…”

Increased monocyte distribution width in COVID‐19 and sepsis arises from a complex interplay of altered monocyte cellular size and subset frequency

“…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.…”

“…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.…”