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

Hou, Sen; Lin, Hui; Chen, Shao Chun; Lin, Chiou Feng; Lin, Sheng Feng

doi:10.3390/jpm11080732

Cited by 29 publications

(35 citation statements)

References 60 publications

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“…Crouser et al 33 found that regardless of SIRS or qSOFA variables, an initial MDW >20.0% (vs. <20.0) significantly increased the incidence of sepsis; Meanwhile, according to Agnello et al 34 meta-analysis data, MDW plays an important role in Sepsis screening regardless of the Sepsis-2 and Sepsis-3 standard groups; therefore, MDW improved the early detection of sepsis in the initial ED and was a good complement to SIRS and qSOFA parameters. Similarly, the combination of MDW and white blood cell count (WBC), 35 neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) 36 significantly improved the early diagnosis of sepsis. It has been proved that the diagnostic performance of MDW was comparable to that of traditional diagnostic biomarkers (PCT, CRP), and the combined diagnosis could enhance the effect to some extent, but not significantly.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Wu¹,

Li²,

Luo³

2022

JIR

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Monocyte distribution width (MDW) is a blood monocyte morphological parameter that can be easily detected by an automated hemocyte analyzer and can provide clinicians with important information about cell volume variability in peripheral blood monocyte populations. The United States’ Food and Drug Administration and Conformite Europeenne have both been cleared for their clinical application in the detection of sepsis and developing sepsis in adult patients in the emergency department (ED). Recently, MDW has been found to have an early diagnosis and predictive value for sepsis in neonates and COVID-19 patients. Here, we summarize the findings of the studies investigating the clinical application of MDW in sepsis. Under different stimuli, especially in infectious diseases, the activation of innate immunity is the host’s first defense mechanism, and the change in monocyte volume is considered an early indicator reflecting the state of activation of innate immunity. Pivotal study data from a large multicenter patient cohort showed that abnormal MDW at presentation increases the odds of sepsis, considering the combination of MDW and White Blood Cell Count (WBC) as part of a standard sepsis assessment protocol for ED, which may increase the sensitivity and specificity of sepsis diagnosis. Meanwhile, MDW shares a diagnostic performance comparable to that of conventional biomarkers (C-reactive protein and procalcitonin) in sepsis. In addition, some evidence suggests that increased MDW, both in adults and neonates, may be associated with unfavorable short- and long-term outcomes, which indicates its prognostic value in sepsis. Taken together, MDW is a parameter of increased morphological variability of monocytes in response to infection, and numerous studies have shown that MDW could be used as a valuable diagnostic and prognostic index in patients with sepsis or suspected sepsis.

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Section: Introductionmentioning

confidence: 99%

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Wu¹,

Li²,

Luo³

2022

JIR

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“…MDW, a new biomarker used to predict sepsis [ 40 ], was used to distinguish COVID-19 from other common respiratory tract infections in a prior study [ 46 ]. A higher MDW reflects more active inflammation activity and greater infection severity and organ dysfunction [ 38 , 62 ], factors which contribute to a prolonged LOS.…”

Section: Discussionmentioning

confidence: 99%

“…Monocytes, acting as proinflammatory cytokines, increase markedly during early inflammation [ 33 , 34 ] and are the key members of the mononuclear phagocyte system, an essential part of the innate immunity [ 35 , 36 ]. Monocyte distribution width (MDW) has been employed as an early biomarker to evaluate early septic change in ED settings [ 37 , 38 , 39 , 40 ]. MDW is responsive to bacterial and viral pathogens [ 41 , 42 , 43 ], and the magnitude of increase of MDW is correlated with the intensity of infection and sepsis [ 37 , 38 , 39 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

“…Monocyte distribution width (MDW) has been employed as an early biomarker to evaluate early septic change in ED settings [ 37 , 38 , 39 , 40 ]. MDW is responsive to bacterial and viral pathogens [ 41 , 42 , 43 ], and the magnitude of increase of MDW is correlated with the intensity of infection and sepsis [ 37 , 38 , 39 , 40 ]. MDW is strongly associated with COVID-19 [ 26 , 44 , 45 ] and can be used to distinguish COVID-19 from other upper airway infections [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

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Fever, Tachypnea, and Monocyte Distribution Width Predicts Length of Stay for Patients with COVID-19: A Pioneer Study

Lin

Chuang

et al. 2022

JPM

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(1) Background: Our study investigated whether monocyte distribution width (MDW) could be used in emergency department (ED) settings as a predictor of prolonged length of stay (LOS) for patients with COVID-19. (2) Methods: A retrospective cohort study was conducted; patients presenting to the ED of an academic hospital with confirmed COVID-19 were enrolled. Multivariable logistic regression models were used to obtain the odds ratios (ORs) for predictors of an LOS of >14 days. A validation study for the association between MDW and cycle of threshold (Ct) value was performed. (3) Results: Fever > 38 °C (OR: 2.82, 95% CI, 1.13–7.02, p = 0.0259), tachypnea (OR: 4.76, 95% CI, 1.67–13.55, p = 0.0034), and MDW ≥ 21 (OR: 5.67, 95% CI, 1.19–27.10, p = 0.0269) were robust significant predictors of an LOS of >14 days. We developed a new scoring system in which patients were assigned 1 point for fever > 38 °C, 2 points for tachypnea > 20 breath/min, and 3 points for MDW ≥ 21. The optimal cutoff was a score of ≥2. MDW was negatively associated with Ct value (β: −0.32 per day, standard error = 0.12, p = 0.0099). (4) Conclusions: Elevated MDW was associated with a prolonged LOS.

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“…We observed signi cant correlations between M3 and WPR0 and the development of bacteremia. Further analysis showed that TBSAB, SOFA core and ∆M (M0-M3) were incorporated into the prediction model for 90-day mortality [29,30]. These readily available parameters represent burn severity, vital organ function, and immune status.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of perioperative monocyte counts for bacteremia and 90-day all-cause mortality in patients with severe burn

Chen

et al. 2022

Preprint

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Objective To explore the predictive value of changes in monocytes (M), lymphocytes (L), white blood cell-to-platelet ratio (WPR), neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and changes in temperature (T-37) for bacteremia and 90-day mortality in patients with severe burns during the first perioperative period.Methods Data from 169 patients treated at the First Affiliated Hospital of Sun Yat-sen University from 2011 to 2020 were retrospectively analyzed. The patients were divided into a bacteremia group and a control group based upon blood culture. Data on M, L, NLR, WPR and T-37 were collected at the day before the first surgery (0), the first day after the first surgery (1) and the third day after the first surgery (3). Independent risk factors for bacteremia and 90-day mortality were identified. The risk prediction models were established with multivariate logistic regression analysis and externally validated in another cohort of 191 patients with severe burns.Results The 90-day mortality rate was 21.3% (36/169), which was significantly higher in the Bac group than in the con group (42.8% vs. 10.6%, P<0.01). WPR0, M0, WPR1, and T3-37 were significantly higher in the Bac group than in the con group (P<0.01), whereas M1 and M3 were significantly lower in the Bac group than in the con group (P<0.01). Multivariate regression analysis showed that SOFA0, WPR0, M3, and T3-37 were independently associated with bacteremia. The prediction model for bacteremia Xbac = 0.1809 × SOFA0 + 6.532 × WPR0-1.171 × M3 + 0.6987 × ⎮T3-37⎮- 2.297. TBSAB, SOFA0, and ∆M (M0-M3) were independently correlated with 90-day mortality. The risk prediction model X90d-m= 0.055 × TBSAB + 0.301×SOFA0+1.508 × ∆M) - 7.196. External validation of the prediction models suggested that the specificity, sensitivity, and AUC were 90.7%, 62.5% and 0.797, respectively, for Xbac and 69.2%, 90.0% and 0.873, respectively, for X90d-m.Conclusion ∆M and WPR0 were independent risk factors for bacteremia and 90-day mortality in patients with severe burns. The predictive models could inform clinical antimicrobial judgment and prognostication.

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

Cited by 29 publications

References 60 publications

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Fever, Tachypnea, and Monocyte Distribution Width Predicts Length of Stay for Patients with COVID-19: A Pioneer Study

Predictive value of perioperative monocyte counts for bacteremia and 90-day all-cause mortality in patients with severe burn

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