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Published on: December 9, 2022
Monocyte distribution width compared with C-reactive protein and procalcitonin for early sepsis detection in the
A la Woo1, Dong Kyu Oh1, Chan-Jeoung Park2
1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Purpose:
Monocyte distribution width (MDW) has been suggested as an early biomarker of sepsis, but few studies have compared MDW with conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT). This study evaluated MDW as a biomarker for sepsis and compared it with CRP and PCT.
Materials And Methods:
Patients aged 18-80 years who visited the emergency department were screened and prospectively enrolled in a tertiary medical center. Complete blood count, MDW, CRP, and PCT were examined. Diagnostic performance for sepsis was tested using the area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity.
Results:
In total, 665 patients were screened, and 549 patients with valid laboratory test results were included in the analysis. The patients were categorized into three groups according to the Sepsis-3 criteria: non-infection, infection, and sepsis. MDW showed the highest value in the sepsis group (median [interquartile range], 24.0 [20.8-27.8]). The AUC values for MDW, CRP, PCT, and white blood cells for predicting sepsis were 0.71 (95% confidence interval [CI], 0.67-0.75), 0.75 (95% CI, 0.71-0.78], 0.76 (95% CI, 0.72-0.79, and 0.61 (95% CI, 0.57-0.65), respectively. With the optimal cutoff value of the cohort, the sensitivity was 83.0% for MDW (cutoff, 19.8), 69.7% for CRP (cutoff, 4.0), and 76.6% for PCT (cutoff, 0.05). The combination of quick Sequential Organ Failure Assessment (qSOFA) with MDW improved the AUC (0.76; 95% CI, 0.72-0.80) to a greater extent than qSOFA alone (0.67; 95% CI, 0.62-0.72).
Conclusions:
MDW reflected a diagnostic performance comparable to that of conventional diagnostic markers, implying that MDW is an alternative biomarker. The combination of MDW and qSOFA improves the diagnostic performance for early sepsis.
Insights
Monocyte distribution width (MDW) shows diagnostic performance comparable to C-reactive protein (CRP) and procalcitonin (PCT) for sepsis. Combining MDW with quick Sequential Organ Failure Assessment (qSOFA) enhances early sepsis detection.
Area of Science:
- Clinical diagnostics
- Biomarker discovery
- Sepsis research
Background:
- Monocyte distribution width (MDW) is a potential early sepsis biomarker.
- Limited comparative studies exist between MDW and conventional sepsis markers like CRP and PCT.
Purpose of the Study:
- To evaluate MDW as a sepsis biomarker.
- To compare the diagnostic performance of MDW against CRP and PCT.
Main Methods:
- Prospective enrollment of 549 adult emergency department patients.
- Laboratory tests included complete blood count, MDW, CRP, and PCT.
- Diagnostic performance assessed using ROC curves, sensitivity, and specificity.
Main Results:
- MDW levels were highest in the sepsis group.
- MDW demonstrated an AUC of 0.71, comparable to CRP (0.75) and PCT (0.76).
- MDW achieved 83.0% sensitivity at a cutoff of 19.8.
- Combining MDW with qSOFA improved AUC to 0.76, outperforming qSOFA alone (0.67).
Conclusions:
- MDW exhibits diagnostic performance comparable to established sepsis biomarkers.
- MDW serves as a viable alternative biomarker for sepsis diagnosis.
- The combination of MDW and qSOFA significantly enhances early sepsis detection capabilities.
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