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Published on: August 12, 2019
Elevated monocyte distribution width in trauma: An early cellular biomarker of organ dysfunction
Adrián Marcos-Morales1, Jesús Abelardo Barea-Mendoza1, Carlos García-Fuentes1
1Servicio de Medicina Intensiva, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Intensive Care Medicine, Spain.
Introduction:
Traumatic injury elicits an inflammatory response such as the one occurring during systemic infection. Monocyte distribution width (MDW) has been found to distinguish sepsis in a pool of patients with suspected infection. We hypothesized that an elevated MDW in trauma patients would be associated with the development of multiple organ dysfunction syndrome (MODS) and an increased mortality.
Materials And Methods:
Observational study in a dedicated trauma Intensive Care Unit (ICU) in Madrid during 2019-2020. Patients were classified according to their first MDW value on admission, as greater or lesser than 21 U. Clinical data was obtained and univariate and multivariate analysis were realized, as well as a test performance analysis.
Results:
354 patients were studied, with a median age of 46 years, 78% male. Half presented with severe trauma ISS > 15, mostly with a blunt mechanism of injury. A MDW ≥ 21 U on admission was found in 17% of cases. These patients were more likely to present with hemodynamic instability and MODS. They had a higher length of stay (3.8 vs 2 days) and higher mortality (21 vs 5%) compared to the low MDW group. These findings remained statistically significant in the multivariate analysis, with an OR 4.6 (IC 95% 1.7-12) for MODS and 3.1 (IC 95% 1.2-8.3) for mortality.
Conclusions:
In trauma patients, a MDW ≥ 21 U on admission was independently associated with a greater risk of MODS, a higher mortality and a higher length of stay. This biomarker could be useful in predicting severity in the initial evaluation of trauma patients.
Insights
Elevated Monocyte Distribution Width (MDW) in trauma patients indicates a higher risk of multiple organ dysfunction syndrome (MODS) and increased mortality. This simple blood test can help predict severity upon initial evaluation.
Area of Science:
- Trauma critical care
- Inflammatory biomarkers
- Clinical pathology
Background:
- Traumatic injuries trigger inflammatory responses similar to systemic infections.
- Monocyte Distribution Width (MDW) can differentiate sepsis in patients with suspected infections.
- The study investigated MDW's role in predicting outcomes for trauma patients.
Purpose of the Study:
- To determine if elevated MDW in trauma patients is associated with multiple organ dysfunction syndrome (MODS).
- To assess the correlation between elevated MDW and increased mortality in trauma patients.
- To evaluate MDW as a predictive biomarker for trauma severity.
Main Methods:
- An observational study was conducted in a trauma Intensive Care Unit (ICU) from 2019-2020.
- Patients were categorized based on their initial MDW value (≥21 U vs. <21 U).
- Statistical analyses included univariate, multivariate, and test performance analyses.
Main Results:
- 17% of 354 trauma patients had an initial MDW ≥21 U.
- Higher MDW was linked to hemodynamic instability and MODS.
- Patients with higher MDW experienced longer hospital stays (3.8 vs. 2 days) and increased mortality (21% vs. 5%).
- Multivariate analysis confirmed significant associations: OR 4.6 for MODS and OR 3.1 for mortality.
Conclusions:
- An admission MDW ≥21 U is an independent predictor of MODS risk in trauma patients.
- Elevated MDW is associated with higher mortality and prolonged length of stay.
- MDW serves as a valuable biomarker for initial trauma severity assessment.
