Related Experiment Video
Updated: Aug 14, 2025
Quantification of Monocyte Transmigration and Foam Cell Formation from Individuals with Chronic Inflammatory Conditions
Published on: October 17, 2017
Deciphering the role of monocyte and monocyte distribution width (MDW) in COVID-19: an updated systematic review and
Daniela Ligi1, Bruna Lo Sasso2, Brandon M Henry3
1Unit of Clinical Biochemistry, Section of Biochemistry and Biotechnology, Department of Biomolecular Sciences-DISB, University of Urbino Carlo Bo, Urbino, Italy.
Insights
Increased monocyte distribution width (MDW) in COVID-19 patients indicates a higher risk of severe disease and poor outcomes. Monitoring MDW can aid in early risk stratification and treatment decisions for SARS-CoV-2 infection.
Area of Science:
- Immunology
- Hematology
- Infectious Diseases
Background:
- SARS-CoV-2 infection causes systemic hyper-thromboinflammation, with monocytes/macrophages playing a key role as immune cell players.
- Previous studies suggest monocyte distribution width (MDW) correlates with COVID-19 patient outcomes.
- Understanding monocyte roles in SARS-CoV-2 infection is crucial for prognosis.
Approach:
- Conducted an updated literature review and meta-analysis using Medline and Scopus.
- Investigated the association between elevated MDW levels and COVID-19 severity.
- Analyzed the roles and functions of monocytes in SARS-CoV-2 pathogenesis.
Key Points:
- Significantly elevated MDW values were frequently observed in COVID-19 patients with unfavorable clinical outcomes.
- A significant association exists between monocyte anisocytosis (variation in size) and adverse SARS-CoV-2 outcomes.
- MDW may serve as a valuable diagnostic and prognostic marker for innate cellular immunity.
Conclusions:
- Blood MDW index and scatter plots can be routine laboratory tools for early identification of high-risk COVID-19 patients.
- Monitoring MDW aids in tracking viral infection progression, clinical outcomes, and therapeutic efficacy.
- Therapeutic strategies for severe/critical COVID-19 may benefit from MDW monitoring to manage monocyte hyper-activation and thrombo-inflammation.
Abstract:
The SARS-CoV-2 infection is characterized by both systemic and organ hyper-thromboinflammation, with a clinical course ranging from mild up-to critical systemic dysfunction and death. In patients with coronavirus disease 2019 (COVID-19) the monocyte/macrophage population is deeply involved as both trigger and target, assuming the value of useful diagnostic/prognostic marker of innate cellular immunity. Several studies correlated morphological and immunophenotypic alterations of circulating monocytes with clinical outcomes in COVID-19 patients, concluding that monocyte distribution width (MDW) may retain clinical value in stratifying the risk of disease worsening. Through an electronic search in Medline and Scopus we performed an updated literature review and meta-analysis aimed to explore the association between increased MDW levels and illness severity in COVID-19 patients, deciphering role(s) and function(s) of monocytes in the harmful network underlining SARS-CoV-2 infection. We found that significantly elevated MDW values were frequently present in COVID-19 patients who developed unfavorable clinical outcomes, compounded by a significant association between monocyte anisocytosis and SARS-CoV-2 outcomes. These findings suggest that blood MDW index and its scatter plot could represent useful routine laboratory tools for early identification of patients at higher risk of unfavorable COVID-19 and for monitoring the progression of viral infection, clinical outcomes, and therapeutic efficacy throughout hospitalization. According to this evidence, therapeutic decisions in patients with SARS-CoV-2 infection could benefit from monitoring MDW value, with administration of drugs limiting thrombo-inflammation due to monocyte hyper-activation in patients with severe/critical COVID-19 disease.
