Related Experiment Video
Updated: Aug 21, 2026
Prediction of Red Blood Cell Antibody Significance Using the Monocyte-Macrophage Assay
Published on: February 7, 2025
Diagnostic accuracy and severity prediction of monocyte distribution width in sepsis: a retrospective study from the
Uzma Sabahat1, Liza Thomas1, Eram Anwar2
1Department of Internal Medicine, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates.
Introduction:
Monocyte distribution width (MDW) is an early sepsis biomarker derived from the routine complete blood count. Existing evidence is overwhelmingly from European, North American, and East Asian cohorts, with no published Middle Eastern data. We evaluated the diagnostic value of MDW for sepsis identification in a United Arab Emirates (UAE) tertiary care population, comparing it with procalcitonin (PCT), C-reactive protein (CRP), and quick Sequential Organ Failure Assessment (qSOFA).
Methods:
We retrospectively reviewed 140 adults admitted to Rashid Hospital, Dubai, with confirmed infections in 2024, classified by Sepsis-3 criteria as sepsis (n = 53), septic shock (n = 21), or other infections (n = 66). MDW was measured on a UniCel DxH 900 analyzer. Receiver operating characteristic curves were compared for MDW, CRP, PCT, WBC, and the MDW + qSOFA and CRP + qSOFA composites; logistic regression identified independent predictors of sepsis.
Results:
Median MDW differed across groups: 27.6 (IQR 22.6-34.6) in sepsis, 28.2 (25.4-33.0) in septic shock, and 24.0 (19.9-27.6) in other infections (p = 0.001). MDW's AUC was 0.678 (95% CI 0.589-0.764), behind PCT (0.778) and ahead of CRP (0.652) and WBC (0.590). MDW + qSOFA achieved the highest AUC (0.763, 95% CI 0.683-0.840), indistinguishable from CRP + qSOFA (p = 0.550). At the FDA-cleared cutoff ≥ 20, MDW had 90.5% sensitivity and 25.8% specificity, supporting a rule-out role. After adjustment for CRP, PCT, age, and sex, only MDW (aOR 1.08; 95% CI 1.00-1.15; p = 0.037) and qSOFA (aOR 2.30; 95% CI 1.32-4.00; p = 0.003) remained independent predictors. MDW was also higher in blood culture-positive patients (median 29.5 vs. 25.0; p = 0.028), though this attenuated to borderline significance (p = 0.051) after excluding the 12 patients without cultures.
Discussion:
In this first UAE cohort, MDW behaved consistently with international evidence. Standalone discrimination was moderate, but MDW + qSOFA matched a CRP-based composite at no additional sample/reagent cost. As the comparator group comprised only infected patients, these AUCs reflect an infection-enriched design and are expected to be lower than in unselected emergency-department populations. Region-specific cutoffs and prospective multicenter Gulf evaluations are required for further evaluation.
Insights
Monocyte distribution width (MDW) shows moderate diagnostic value for sepsis in the UAE, performing similarly to C-reactive protein (CRP) when combined with quick Sequential Organ Failure Assessment (qSOFA). This early sepsis biomarker can aid in ruling out infection in emergency settings.
Area of Science:
- Clinical Pathology
- Infectious Diseases
- Biomarker Discovery
Background:
- Monocyte distribution width (MDW) is an emerging sepsis biomarker from complete blood counts.
- Previous studies on MDW predominantly originate from North American, European, and East Asian populations.
- There is a lack of published data on MDW's utility in Middle Eastern populations.
Purpose of the Study:
- To evaluate the diagnostic performance of Monocyte distribution width (MDW) for sepsis identification in a United Arab Emirates (UAE) tertiary care setting.
- To compare the efficacy of MDW against established sepsis biomarkers: procalcitonin (PCT), C-reactive protein (CRP), and quick Sequential Organ Failure Assessment (qSOFA).
- To assess the combined diagnostic value of MDW with qSOFA for sepsis detection.
Main Methods:
- Retrospective analysis of 140 adult patients admitted to Rashid Hospital, Dubai, with confirmed infections in 2024.
- Patients were classified according to Sepsis-3 criteria: sepsis (n=53), septic shock (n=21), and other infections (n=66).
- MDW, CRP, PCT, and White Blood Cell (WBC) counts were analyzed; Receiver Operating Characteristic (ROC) curves were generated for individual markers and composite scores (MDW + qSOFA, CRP + qSOFA).
Main Results:
- Median MDW levels were significantly different across sepsis, septic shock, and other infection groups (p=0.001).
- MDW demonstrated moderate diagnostic accuracy (AUC=0.678), outperforming CRP (AUC=0.652) and WBC (AUC=0.590), but below PCT (AUC=0.778).
- The MDW + qSOFA composite yielded the highest AUC (0.763), comparable to CRP + qSOFA, and MDW was identified as an independent predictor of sepsis (aOR 1.08).
Conclusions:
- Monocyte distribution width (MDW) shows consistent performance with international findings in a UAE population, suggesting its potential as an early sepsis biomarker.
- The combination of MDW with qSOFA offers a valuable diagnostic approach, matching the performance of CRP + qSOFA without additional costs.
- Further prospective, multicenter studies in the Gulf region are recommended to establish region-specific cutoffs and validate findings in broader populations.
