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

Polilli, Ennio; Iorio, Giancarlo Di; Silveri, Claudio; Angelini, Gilda; Anelli, Maria Chiara; Esposito, Jessica Elisabetta; D’Amato, Milena; Parruti, Giustino; Carinci, Fabrizio

doi:10.1186/s12879-022-07803-7

Cited by 3 publications

(1 citation statement)

References 59 publications

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“…Those findings are consistent with the previous reports 4 – 14 . The cut-off value 22 for sepsis prediction, as determined in our study, was similar to that reported by Jo et al 6 , Polili et al 13 , 17 and Hausfater et al 19 , yet slightly higher than values obtained in other studies 4 , 5 , 7 , 10 – 12 , 14 – 17 , 19 . This could be explained by the type of anticoagulant used for blood samples.…”

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confidence: 90%

Understanding the value of monocyte distribution width (MDW) in acutely ill medical patients presenting to the emergency department: a prospective single center evaluation

Kralovcova,

Müller,

Hajsmanova

et al. 2024

Sci Rep

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The monocyte distribution width (MDW) has emerged as a promising biomarker for accurate and early identification of patients with potentially life-threatening infections. Here we tested the diagnostic performance of MDW in adult patients requiring hospital admission for community-acquired infections and sepsis, evaluated sources of heterogeneity in the estimates of diagnostic accuracy, and assessed the meaning of MDW in a patient population presenting to the emergency department (ED) for acute non-infectious conditions. 1925 consecutive patients were categorized into three groups: non-infection (n = 1507), infection (n = 316), and sepsis/septic shock (n = 102). Diagnostic performance for infection or sepsis of MDW alone or in combination with components of SOFA was tested using AUC of ROC curves, sensitivity, and specificity. The relationship between MDW and different pathogens as well as the impact of non-infectious conditions on MDW values were explored. For the prediction of infection, the AUC/ROC of MDW (0.84) was nearly overlapping that of procalcitonin (0.83), and C-reactive protein (0.89). Statistical optimal cut-off value for MDW was 21 for predicting infection (sensitivity 73%, specificity 82%) and 22 for predicting sepsis (sensitivity 79%, specificity 83%). The best threshold to rule out infection was MDW ≤ 17 (NPV 96.9, 95% CI 88.3–100.0), and ≤ 18 (NPV 99.5, 95% CI 98.3–100.0) to rule out sepsis. The combination of MDW with markers of organ dysfunction (creatinine, bilirubin, platelets) substantially improved the AUC (0.96 (95% CI 0.94–0.97); specificity and sensitivity of 88% and 94%, respectively). In conclusion, MDW has a good diagnostic performance in diagnosing infection and sepsis in patients presenting in ED. Its use as an infection marker even increases when combined with other markers of organ dysfunction. Understanding the impact of interactions of non-infectious conditions and comorbidities on MDW and its diagnostic accuracy requires further elucidation.

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Section: Discussionsupporting

confidence: 90%

Understanding the value of monocyte distribution width (MDW) in acutely ill medical patients presenting to the emergency department: a prospective single center evaluation

Kralovcova,

Müller,

Hajsmanova

et al. 2024

Sci Rep

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Monocyte Distribution Width (MDW) as a biomarker of sepsis: An evidenced-based laboratory medicine approach

Ciaccio

Agnello

Sasso

et al. 2023

Clinica Chimica Acta

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Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

Cancella de Abreu,

Sala,

Houas

et al. 2024

Crit Care

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Background Timely recognition of sepsis in emergency department (ED) is challenging. We evaluated the impact of implementing the biomarker monocyte distribution width (MDW) at bedside, on the time to anti-infective administration. Methods We conducted a before-and-after cohort study in the ED of an academic hospital in Paris, to compare sepsis patients care and outcomes, before and after the implementation of point of care (POC) MDW measurement in the ED. During post-implementation period (period-2), MDW was measured with complete blood count by ED nurses with results given in 2 min: if above 21.5 units, ED physicians were asked to consider sepsis and to start an anti-infectious as soon as possible. Primary endpoint was time to anti-infectious administration (TTA) from ED arrival, and secondary endpoints were TTA from sepsis onset (TTAS), length of stay, mortality, and hospitalization rates. Results In total, 255 patients (period-1) and 180 patients (period-2) with sepsis were included. The TTA was 5.4 h (3.5–7.7) period-1 and 4.9 h (IQR 2.5–7.1) in period-2 ( p = 0.06). MDW implementation significantly reduced the median TTAS from to 3.7 h (IQR 1.5–5.8) in period-1, to 2.2 h (IQR 0.5–4.5) in period-2 ( p < 0.001). Mortality rates remained similar between the two periods (18% vs. 16% respectively, p = 0.4), as did hospitalization rates (93% vs. 91%, p = 0.4) and ED length of stay (7.2 h (5.3–9.8) vs 7.0 (5.4–9.4), p = 0.7). Conclusion Implementing POC MDW measurement in the ED protocols enhances the timeliness of anti-infective administration from sepsis onset, meeting current sepsis management guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-024-05141-5.

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

Cited by 3 publications

References 59 publications

Understanding the value of monocyte distribution width (MDW) in acutely ill medical patients presenting to the emergency department: a prospective single center evaluation

Understanding the value of monocyte distribution width (MDW) in acutely ill medical patients presenting to the emergency department: a prospective single center evaluation

Monocyte Distribution Width (MDW) as a biomarker of sepsis: An evidenced-based laboratory medicine approach

Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

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