Monocyte Distribution Width as an Early Indicator of Sepsis in ICU Patients
Authors of a Franco-Spanish study propose using the monocyte distribution width along with leukocyte count as a screening test to refine the early diagnosis of sepsis in intensive care unit (ICU) patients based on their research findings.
Methodology, Course, and Objectives of the Study
The monocyte distribution width (MDW) is a recently described sepsis biomarker that is easily available as part of a complete blood count with differential (CBC+diff.). The aim of this study, published in the summer of 2021, was to evaluate the reliability of using MDW to detect sepsis in the ICU compared to procalcitonin and C-reactive protein (CRP).
This was a multicenter prospective study that included adult ICU patients who underwent a complete blood count with differential (CBC+diff.) upon admission. Patients were categorized according to sepsis-2 and sepsis-3 criteria, utilizing the SIRS parameter (systemic inflammatory response syndrome). Sepsis-2 categories: non-SIRS (≥ 1 SIRS criterion and absence of infection), SIRS (≥ 2 SIRS criteria and absence of infection), infection (suspected or confirmed infection and 0–1 SIRS criterion), sepsis (infection plus ≥ 2 SIRS criteria), severe sepsis (sepsis and 1–2 organ failures), and septic shock (sepsis with refractory hypotension). Sepsis-3 categories: controls, infection, and sepsis (according to SOFA criteria).
Results
Data from 1,517 patients (837 men) with an average age of 61 years were included in the analysis. Of these, 17.1% met the sepsis criteria according to sepsis-2, and 9.5% according to sepsis-3. Using MDW, the area under the curve (AUC) for diagnosing sepsis according to sepsis-2 criteria was 0.81 (95% confidence interval [CI] 0.78–0.84), and using MDW in combination with leukocyte count it was 0.86 (95% CI 0.84–0.88). For the subset of patients with a low pre-test probability of sepsis, the AUC was even 0.90 (95% CI 0.84–0.95). For sepsis according to sepsis-3 criteria, the AUC using MDW was 0.82 (95% CI 0.79–0.85).
The reliability of MDW combined with leukocyte count for detecting sepsis was similar to that of CRP alone and greater than that of procalcitonin. Combining these biomarkers did not increase the AUC. Compared to normal MDW, abnormal MDW was associated with a 5.5-times higher likelihood of sepsis according to sepsis-2 criteria and 7.6-times according to sepsis-3 criteria.
Conclusion
The authors conclude that the MDW parameter in combination with leukocyte count exhibits diagnostic accuracy for detecting sepsis, especially when used in patients with a lower pre-test probability of sepsis.
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Source: Hausfater P., Boter N. R., Morales Indiano C. et al. Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study. Crit Care 2021 Jun 30; 25(1): 227, doi: 10.1186/s13054-021-03622-5.
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