Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units

Abstract

Objectives Patients in Intensive Care Units (ICU) are a high-risk population for sepsis, recognized as a major cause of admission and death. The aim of the current study was to evaluate the diagnostic accuracy and prognostication of monocyte distribution width (MDW) in sepsis for patients admitted to ICU. Methods Between January and June 2020, we conducted a prospective observational study during the hospitalization of 506 adult patients admitted to the ICU. MDW was evaluated in 2,367 consecutive samples received for routine complete blood counts (CBC) performed once a day and every day during the study. Sepsis was diagnosed according to Sepsis-3 criteria and patients enrolled were classified in the following groups: no sepsis, sepsis and septic shock. Results MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group [median 26.23 (IQR: 23.48–29.83); 28.97 (IQR: 21.27–37.21); 21.99 (IQR: 19.86–24.36) respectively]. ROC analysis demonstrated that AUC is 0.785 with a sensitivity of 66.88% and specificity of 77.79% at a cut-off point of 24.63. In patients that developed an ICU-acquired sepsis MDW showed an increase from 21.33 [median (IQR: 19.47–21.72)] to 29.19 [median (IQR: 27.46–31.47)]. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19. In sepsis survivors a decrease of MDW values were found from the first time to the end of their stay [median from 29.14 (IQR: 26.22–32.52) to 25.67 (IQR: 22.93–30.28)]. Conclusions In ICU, MDW enhances the sepsis detection and is related to disease severity.

Monocyte Distribution Width, Neutrophil-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio Improves Early Prediction for Sepsis at the Emergency

“…Crouser et al revealed that an MDW of >20.5 differentiated patients with sepsis from those without sepsis in the ED setting [9]. Furthermore, Piva et al showed that a MDW of >24.6 predicted sepsis in ICU patients according to Sepsis-3 criteria [48]. The cutoff value of >20.0 used for MDW in this study is consistent with that used in previous studies in the ED.…”

“…The cutoff values of the MDW were heterogenous among various studies, in which the reference interval for MDW was reported to be from 19 to 25 [9,26,42,43,47,48]. Woo et al indicated that the cutoff value of MDW of >19.8 demonstrated optimized sensitivity and specificity for screening patients with sepsis in the ED [26].…”

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

“…It has been approved by the Food and Drug Administration (FDA) as a biomarker for the early detection of sepsis in ED. Recently, several authors showed that MDW has good diagnostic accuracy for early-identifying patients at high risk of developing sepsis, especially in the ED and the ICU [114][115][116][117][118][119][120][121][122][123]. MDW is characterized by a high negative predictive value for sepsis diagnosis.…”

Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department

“…Specifically, it represents a morphometric indicator of monocyte size variability similar to the red blood cell distribution width. Several authors have assessed the diagnostic performance of MDW as a biomarker of sepsis in different acute clinical settings, including the ED and intensive care unit (ICU), achieving promising results [ 9 , 10 , 11 ]. We also found that the MDW had high sensitivity and specificity for sepsis screening both in the ED and in ICU [ 12 , 13 , 14 ].…”