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Diagnostic efficacy of monocyte distribution width to high-sensitivity C-reactive protein ratio in differentiating
1Clinical Laboratory, The Second Hospital of Hunan University of Chinese Medicine, Changsha City, Hunan, China.
Objectives:
Community-acquired pneumonia (CAP) remains a diagnostic challenge in emergency departments, where rapid and accurate pathogen differentiation is essential for appropriate antimicrobial therapy and stewardship. Current biomarkers demonstrate limited accuracy in distinguishing bacterial from viral and atypical pathogens, necessitating novel diagnostic approaches. This study aimed to assess the diagnostic accuracy of the monocyte distribution width to high-sensitivity C-reactive protein ratio (MDW/hs-CRP) for differentiating bacterial, viral, atypical, and mixed community-acquired pneumonia (CAP) pathogens.
Methods:
This retrospective cohort study enrolled 486 adult patients with radiologically confirmed CAP in an emergency department (Jan 2023-Dec 2024). Pathogens were identified using comprehensive microbiological testing. MDW was measured via automated hematology analyzer (Beckman Coulter DxH900); hs-CRP via standard assays. The primary outcome compared the MDW/hs-CRP ratio's diagnostic accuracy to individual biomarkers using ROC analysis (DeLong test), Youden index (cutoff), decision curve analysis (DCA), and subgroup analyses.
Results:
Pathogen distribution: 198 (40.7 %) bacterial, 142 (29.2 %) viral, 89 (18.3 %) atypical, 57 (11.7 %) mixed. For distinguishing bacterial from viral CAP, the MDW/hs-CRP ratio significantly outperformed MDW alone (AUC 0.752) and hs-CRP alone (AUC 0.798), achieving an AUC of 0.893 (95 % CI: 0.865-0.921; p<0.001). The optimal cutoff (0.185) yielded 85.4 % sensitivity and 82.7 % specificity. Performance remained consistent in subgroups. DCA showed clinical utility across threshold probabilities (15-65 % net benefit).
Conclusions:
The MDW/hs-CRP ratio shows promise as a rapid tool for pathogen differentiation in CAP, potentially aiding early antimicrobial decisions in emergency care. Multicenter validation is needed.
Insights
The monocyte distribution width to high-sensitivity C-reactive protein ratio (MDW/hs-CRP) effectively differentiates bacterial from viral community-acquired pneumonia (CAP). This novel biomarker aids rapid antimicrobial decisions in emergency departments.
Area of Science:
- Medical diagnostics
- Infectious disease research
- Biomarker discovery
Background:
- Community-acquired pneumonia (CAP) diagnosis is challenging in emergency settings.
- Accurate pathogen identification is crucial for effective antimicrobial therapy and stewardship.
- Existing biomarkers lack sufficient accuracy for differentiating CAP pathogens.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the monocyte distribution width to high-sensitivity C-reactive protein ratio (MDW/hs-CRP) for differentiating bacterial, viral, atypical, and mixed CAP pathogens.
- To compare the MDW/hs-CRP ratio's performance against individual biomarkers.
Main Methods:
- Retrospective cohort study of 486 adult patients with radiologically confirmed CAP.
- Pathogen identification via comprehensive microbiological testing.
- MDW measured by automated hematology analyzer; hs-CRP by standard assays.
- Diagnostic accuracy assessed using ROC analysis, Youden index, and decision curve analysis (DCA).
Main Results:
- The MDW/hs-CRP ratio achieved an AUC of 0.893 for distinguishing bacterial from viral CAP, significantly outperforming MDW (AUC 0.752) and hs-CRP (AUC 0.798).
- Optimal cutoff (0.185) provided 85.4% sensitivity and 82.7% specificity.
- DCA indicated clinical utility across a range of threshold probabilities.
Conclusions:
- The MDW/hs-CRP ratio demonstrates potential as a rapid diagnostic tool for CAP pathogen differentiation.
- This biomarker may assist in optimizing early antimicrobial treatment decisions in emergency care.
- Further multicenter validation is recommended.
