Monocyte Distribution Width as a Diagnostic Marker for Infection

Malinovska, Alexandra; Hernried, Benjamin; Lin, Andrew; Badaki-Makun, Oluwakemi; Fenstermacher, Katherine; Ervin, Ann Margret; Ehrhardt, Stephan; Levin, Scott R.; Hinson, Jeremiah S.

doi:10.1016/j.chest.2022.12.049

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…Human studies have demonstrated alterations in levels of numerous biomarkers in sepsis, and their correlation with organ failure and mortality, including markers of endothelial activation and injury, long noncoding RNAs, cancer protein biomarkers, and brain natriuretic peptide (64–68). Markers of leukocyte activation and function also associate with sepsis outcomes (67, 69–72). RBC and platelet parameters may predict sepsis severity and outcomes (73–75).…”

Section: Resultsmentioning

confidence: 99%

Surviving Sepsis Campaign Research Priorities 2023

De Backer,

Deutschman,

Hellman

et al. 2024

Critical Care Medicine

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OBJECTIVES: To identify research priorities in the management, epidemiology, outcome, and pathophysiology of sepsis and septic shock. DESIGN: Shortly after publication of the most recent Surviving Sepsis Campaign Guidelines, the Surviving Sepsis Research Committee, a multiprofessional group of 16 international experts representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, convened virtually and iteratively developed the article and recommendations, which represents an update from the 2018 Surviving Sepsis Campaign Research Priorities. METHODS: Each task force member submitted five research questions on any sepsis-related subject. Committee members then independently ranked their top three priorities from the list generated. The highest rated clinical and basic science questions were developed into the current article. RESULTS: A total of 81 questions were submitted. After merging similar questions, there were 34 clinical and ten basic science research questions submitted for voting. The five top clinical priorities were as follows: 1) what is the best strategy for screening and identification of patients with sepsis, and can predictive modeling assist in real-time recognition of sepsis? 2) what causes organ injury and dysfunction in sepsis, how should it be defined, and how can it be detected? 3) how should fluid resuscitation be individualized initially and beyond? 4) what is the best vasopressor approach for treating the different phases of septic shock? and 5) can a personalized/precision medicine approach identify optimal therapies to improve patient outcomes? The five top basic science priorities were as follows: 1) How can we improve animal models so that they more closely resemble sepsis in humans? 2) What outcome variables maximize correlations between human sepsis and animal models and are therefore most appropriate to use in both? 3) How does sepsis affect the brain, and how do sepsis-induced brain alterations contribute to organ dysfunction? How does sepsis affect interactions between neural, endocrine, and immune systems? 4) How does the microbiome affect sepsis pathobiology? 5) How do genetics and epigenetics influence the development of sepsis, the course of sepsis and the response to treatments for sepsis? CONCLUSIONS: Knowledge advances in multiple clinical domains have been incorporated in progressive iterations of the Surviving Sepsis Campaign guidelines, allowing for evidence-based recommendations for short- and long-term management of sepsis. However, the strength of existing evidence is modest with significant knowledge gaps and mortality from sepsis remains high. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Resultsmentioning

confidence: 99%

Surviving Sepsis Campaign Research Priorities 2023

De Backer,

Deutschman,

Hellman

et al. 2024

Critical Care Medicine

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“…It is hence not surprising that we found a high degree of heterogeneity of monocyte volumes in our experiments (i.e., the higher MO-WZ) which could be reflected by an increased value of the monocyte distribution width (MDW; i.e., the relative change in the volume of circulating monocytes). Recent studies and meta-analyses concluded that the MDW is not only increased in patients with SARS-CoV-2 infection compared to those without [28], but is also a significant predictor of unfavorable clinical progression in those with COVID-19 [29][30][31][32]. Importantly, platelet phagocytosis could also be observed especially in specimens challenged with 20 ng/mL of Alpha and Delta recombinant spike protein (Figure 4), a pathological process that has been previously described in the blood smears of patients with SARS-CoV-2 infection and reflecting intense monocyte activation and haemophagocytic lymphohistiocytosis [33], a frequent condition seen in patients with COVID-19 [34].…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Types of Recombinant SARS-CoV-2 Spike Protein on Circulating Monocytes Structure

Vettori¹,

Dima²,

Henry³

et al. 2023

Preprint

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Background: This study investigated the biological effects on circulating monocytes after challenge with SARS-CoV-2 recombinant spike protein. Methods: Whole blood collected form seven ostensibly healthy healthcare workers was incubated for 15 min with 2 and 20 ng/mL recombinant spike protein of Ancestral, Alpha, Delta and Omicron variants. Samples were analyzed with Sysmex XN and DI-60 analyzers. Results: Cellular complexity (i.e., presence of granules, vacuoles and other cytoplasmic inclusions) increased in all samples challenged with the recombinant spike protein of Ancestral, Alpha and Delta variants, but not in those containing Omicron. The cellular content of nucleic acids was constantly decreased in most samples, achieving statistical significance in those containing 20 ng/mL of Alpha and Delta recombinant spike proteins. The heterogeneity of monocyte volumes significantly increased in all samples, achieving statistical significance in those containing 20 ng/mL of recombinant spike protein of Ancestral, Alpha and Delta variants. The monocyte morphological abnormalities after spike protein challenge included dysmorphia, granulation, intense vacuolization, platelet phagocytosis, development of aberrant nuclei and cytoplasmic extrusions. Conclusions: The SARS-CoV-2 spike protein triggers important monocyte morphological abnormalities, more evident in cells challenged with spike protein of the more clinically severe Alpha and Delta variants.

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“…The inclusion of MDW in guidelines defining its exact use and cut-off values as an early indicator of infection and sepsis is necessary since discrepancies have been observed in different studies. Another systematic review concluded that diagnostic thresholds for sepsis should be chosen taking into account the reference standard and tube type used [ 33 ]. The implementation of this biomarker in routine practice would require consensus.…”

Section: Discussionmentioning

confidence: 99%

Monocyte distribution width (MDW) as an infection indicator in severe patients attending in the Emergency Department: a pilot study

Encabo¹,

Hernández-Álvarez²,

Oteo³

et al. 2023

Rev Esp Quimioter

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Background. The aim of the present study was to evaluate the diagnostic performance of monocyte distribution width (MDW) as a biomarker for sepsis diagnosis in severe patients attended in the Emergency Department for different conditions and not only infections. Methods. We performed an observational study in a consecutive prospective cohort including severe patients attending the Emergency Department with different conditions. MDW and other biomarkers were determined from samples obtained during the first care of patients. The diagnostic performance of the different biomarkers was determined based on the final diagnosis at patient discharge. Results. One hundred two patients, with a mean age of 76.7 (SD 16.5) years were included, 53 being (51.9%) male. Among the patients included, 65 (63.7%) had an infectious disease while the remaining had other different conditions. A MDW cut-off of 20.115 provided the best accuracy to identify infected patients, with a sensitivity of 89.2 (95% CI 79.4-94.7), a specificity of 89.2 (95% CI 75.3-95.7), a positive predictive value of 93.5 (95% CI 84.6-97.5), a negative predictive value of 82.5% (95% CI 68.0-91.3), a positive likelihood ratio of 8.25 (3.26-20.91), and a negative likelihood ratio of 0.12 (0.06-0.24). The area under the receiver operating characteristic curve for infection according to MDW was 0.943 (95% CI 0.897-0.989; p<0.001). Conclusions. A MDW > 20.115 may be associated with infection and could help to distinguish between infected and non-infected patients in severe patients. These results must be confirmed in new studies due to the limited patient sample included.

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Monocyte Distribution Width as a Diagnostic Marker for Infection

Cited by 14 publications

References 40 publications

Surviving Sepsis Campaign Research Priorities 2023

Surviving Sepsis Campaign Research Priorities 2023

Effects of Different Types of Recombinant SARS-CoV-2 Spike Protein on Circulating Monocytes Structure

Monocyte distribution width (MDW) as an infection indicator in severe patients attending in the Emergency Department: a pilot study

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