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Value of monocyte distribution width for predicting severe cholecystitis: a retrospective cohort study
Chih-Hao Kao1,2, Yen-Hung Liu1,3,2, Wei-Kung Chen1,2
1Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Insights
Monocyte distribution width (MDW) can predict severe cholecystitis and prolonged hospital stays. This simple blood test offers early insights into gallbladder inflammation severity, aiding clinical decisions.
Area of Science:
- Medical diagnostics
- Inflammatory markers
Background:
- Acute cholecystitis is gallbladder inflammation.
- Tokyo Guidelines 2018 (TG18) assess severity but require many parameters.
- Monocyte distribution width (MDW) is an early sepsis detection marker.
Purpose of the Study:
- Investigate the correlation between MDW and cholecystitis severity.
- Evaluate MDW as a predictor for severe cholecystitis and prolonged hospital stay.
Main Methods:
- Retrospective study of 331 cholecystitis patients (Nov 2020 - Aug 2021).
- Primary outcome: severe cholecystitis (ICU admission or mortality).
- Secondary outcomes: length of stay, ICU stay, TG18 grade.
Main Results:
- Average MDW for TG18 grades 1, 2, and 3 were 20.21, 20.34, and 25.77.
- Severe cholecystitis patients had an average MDW of 25.42.
- MDW ≥ 21.6 predicted higher risk of severe cholecystitis (OR=4.94, p=0.003) and prolonged hospital stay.
Conclusions:
- MDW is a reliable indicator for severe cholecystitis.
- MDW ≥ 21.6 is associated with increased risk and prolonged hospital stay.
- MDW testing can provide simple, early information for predicting cholecystitis severity.
Objectives:
Acute cholecystitis is a gallbladder inflammation, and the Tokyo Guidelines 2018 (TG18) can be used to predict its presence and severity with high sensitivity and specificity. However, TG18 grading require the collection of excessive parameters. Monocyte distribution width (MDW) is a parameter used to detect sepsis early. Therefore, we investigated the correlation between MDW and cholecystitis severity.
Methods:
We conducted a retrospective study of patients with cholecystitis admitted to our hospital from November 1, 2020, to August 31, 2021. The primary outcome was severe cholecystitis analyzed as a composite of intensive care unit (ICU) admission and mortality. The secondary outcomes were length of hospital stay, ICU stay, and TG18 grade.
Results:
A total of 331 patients with cholecystitis were enrolled in this study. The average MDWs for TG18 grades 1, 2, and 3 were 20.21 ± 3.99, 20.34 ± 3.68, and 25.77 ± 6.61, respectively. For patients with severe cholecystitis, the average MDW was 25.42 ± 6.83. Using the Youden J statistic, we set a cutoff MDW of 21.6. Multivariate logistic regression revealed that patients with an MDW≥21.6 had a higher risk of severe cholecystitis (odds ratio=4.94; 95 % CI, 1.71-14.21; p=0.003). The Cox model revealed that patients with an MDW≥21.6 were more likely to have a prolonged hospital stay.
Conclusions:
MDW is a reliable indicator of severe cholecystitis and prolonged length of stay. Additional MDW testing and a complete blood count may provide simple information for predicting severe cholecystitis early.
