Monocyte Distribution Width as a Biomarker for Predicting Bacteremia: A Retrospective Study in the Emergency...

Area of Science:

• Clinical diagnostics
• Hematology
• Infectious disease biomarkers

Background:

• Blood cultures are the gold standard for bacteremia diagnosis but have long turnaround times.
• Delayed diagnosis of bacteremia can impede timely antimicrobial therapy.
• Rapid, accessible biomarkers are needed for early bacteremia detection in the emergency department.

Purpose of the Study:

• To evaluate monocyte distribution width (MDW) as a rapid biomarker for bacteremia.
• To compare the diagnostic performance of MDW against established markers like C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR).
• To assess the utility of combined biomarker models for improved bacteremia detection.

Main Methods:

• Retrospective analysis of adult emergency department patients with complete data for MDW, white blood cell count (WBC), CRP, and NLR.
• Area under the receiver operating characteristic curve (AUROC) was used to assess discrimination.
• Sensitivity, specificity, diagnostic odds ratio (DOR), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated.

Main Results:

• Among 19,325 patients, 10.4% had positive blood cultures.
• MDW demonstrated the highest AUROC (0.760) compared to CRP (0.730), NLR (0.695), and WBC (0.642).
• The combined MDW+NLR model showed superior performance (AUROC 0.785; DOR 6.39).

Conclusions:

• MDW is a rapid and effective biomarker for identifying bacteremia in the emergency department.
• Combining MDW with NLR enhances diagnostic performance for bacteremia.
• MDW offers a promising alternative or adjunct to traditional blood cultures for early sepsis detection.