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Published on: October 17, 2017
Elevated monocyte distribution width in patients with active adult-onset Still's disease: a novel activity indicator
Yun-Hsien Lin1, Shih-Hsin Chang2, Teng-Chieh Hsu1
1Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.
Objectives:
Monocyte distribution width (MDW) correlates with volume modifications of circulating monocytes upon activation. Given the crucial role of monocyte activation in the pathogenesis of adult-onset Still's disease (AOSD), we aimed to examine the associations between MDW and disease activity or inflammatory parameters in this disease.
Methods:
In 58 AOSD patients and 95 other patients with coronavirus disease 2019 (COVID-19) as disease control, MDW and complete blood count were determined using a UniCel DxH800 analyser. C-reactive protein (CRP) levels were measured by nephelometry, and ferritin levels by chemiluminescent immunoassay. AOSD activity was assessed using a modified Pouchot score.
Results:
MDW was significantly higher in active AOSD patients (median 28.3, interquartile range [IQR] 23.3-32.1) compared with inactive AOSD (19.2, IQR 18.0-20.6, p<0.001) or non-severe COVID-19 patients (23.2, IQR 21.0-25.2, p<0.01). MDW was positively correlated with AOSD activity scores, CRP, and ferritin levels (all p<0.001). Longitudinal follow-up evaluation revealed that median MDW significantly declined (28.3 versus 18.5, p<0.001) along with disease activity, paralleling a decrease in CRP and ferritin levels. Severe COVID-19 and sepsis patients had elevated MDW, which were not different from active AOSD patients. Multivariate analysis revealed MDW as a significant predictor of active AOSD, and MDW threshold at 21.7 could predict an active status with a high sensitivity of 91.3% and specificity of 94.3%.
Conclusions:
Elevated MDW and its positive correlation with inflammatory parameters in AOSD patients indicate MDW as a novel activity indicator, with a high MDW value above 21.7 linked to a high probability of active AOSD.
Insights
Monocyte distribution width (MDW) is a new indicator for adult-onset Still's disease (AOSD) activity. Higher MDW levels correlate with increased inflammation and disease severity in AOSD patients.
Area of Science:
- Hematology
- Immunology
- Rheumatology
Background:
- Monocyte distribution width (MDW) reflects monocyte activation and volume changes.
- Monocyte activation is critical in the pathogenesis of adult-onset Still's disease (AOSD).
Purpose of the Study:
- To investigate the association between MDW and disease activity in AOSD.
- To evaluate MDW as a potential biomarker for AOSD activity and inflammation.
Main Methods:
- MDW and complete blood counts were analyzed in 58 AOSD patients and 95 COVID-19 patients.
- C-reactive protein (CRP) and ferritin levels were measured.
- AOSD disease activity was assessed using a modified Pouchot score.
Main Results:
- MDW was significantly higher in active AOSD patients compared to inactive AOSD and non-severe COVID-19 patients.
- MDW positively correlated with AOSD activity scores, CRP, and ferritin levels.
- A MDW threshold of 21.7 demonstrated high sensitivity (91.3%) and specificity (94.3%) for predicting active AOSD.
Conclusions:
- Elevated MDW is associated with active AOSD and correlates with inflammatory markers.
- MDW serves as a novel and sensitive indicator of disease activity in AOSD.
- A high MDW value (above 21.7) suggests a high probability of active AOSD.
