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Published on: September 7, 2022
Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining
Sen-Kuang Hou1,2, Hui-An Lin1,3, Hung-Wei Tsai1
1Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Insights
Increased monocyte distribution width (MDW) is linked to early pediatric sepsis diagnosis in children aged 6 and older. This finding highlights MDW as a potential biomarker for identifying sepsis in this age group.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Infectious Diseases
Background:
- Pediatric sepsis is a life-threatening condition requiring early diagnosis and treatment.
- Current diagnostic markers for pediatric sepsis can be non-specific.
- Monocyte distribution width (MDW) is an emerging biomarker reflecting monocyte size heterogeneity.
Purpose of the Study:
- To evaluate the association between elevated monocyte distribution width (MDW) and the presence of pediatric sepsis in the emergency department (ED).
- To determine if MDW can serve as an early indicator for sepsis in children.
Main Methods:
- A retrospective cohort study was conducted at a single academic hospital.
- Patients aged 0-18 years presenting to the ED with systemic inflammatory response syndrome (SIRS) were enrolled.
- Complete blood count, neutrophil-to-lymphocyte ratio (NLR), and MDW were analyzed using logistic regression to assess association with sepsis.
Main Results:
- In multivariable analysis, MDW > 23 U was significantly associated with pediatric sepsis (OR, 4.97).
- Other significant predictors included NLR > 6, elevated WBC count, and SIRS score.
- MDW > 23 U remained a strong predictor in children aged 6-18 years (ORs 6.76-17.49).
Conclusions:
- Elevated MDW (> 23 U) at presentation is associated with early sepsis diagnosis in children aged 6 years and older.
- MDW shows potential as a valuable biomarker for sepsis stratification in pediatric populations.
- Further research may incorporate MDW into sepsis screening protocols for children.
Objectives:
To investigate the association between increased monocyte distribution width (MDW) and pediatric sepsis in the emergency department (ED).
Design:
Retrospective cohort study.
Setting:
A single academic hospital study.
Patients:
Patients from birth to the age of 18 years who presented at the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were consecutively enrolled. Sepsis was diagnosed using the International Pediatric Surviving Sepsis Campaign criteria.
Interventions:
Antibiotic treatment was administrated once infection was suspected.
Measurements And Main Results:
Routine complete blood cell count, neutrophil-to-lymphocyte ratio (NLR), and MDW, a new inflammatory biomarker, were evaluated in the ED. Logistic regression models were used to explore associations with early pediatric sepsis. We included 201 patients with sepsis and 1,050 without sepsis. In the multivariable model, MDW greater than 23 U (odds ratio [OR], 4.97; 95% CI, 3.42-7.22; p < 0.0001), NLR greater than 6 (OR, 2.06; 95% CI, 1.43-2.94; p = 0.0001), WBC greater than 11,000 cells/µL (OR, 6.52; 95% CI, 4.45-9.53; p < 0.0001), and the SIRS score (OR, 3.42; 95% CI, 2.57-4.55; p < 0.0001) were associated with pediatric sepsis. In subgroup analysis, MDW greater than 23 U remained significantly associated with sepsis for children 6-12 years old (OR, 6.76; 95% CI, 2.60-17.57; p = 0.0001) and 13-18 years (OR, 17.49; 95% CI, 7.69-39.76; p = 0.0001) with an area under the receiver operating curve of 0.8-0.9.
Conclusions:
MDW greater than 23 U at presentation is associated with the early diagnosis of sepsis in children greater than or equal to 6 years old. This parameter should be considered as a stratification variable in studies of pediatric sepsis.
