Abstract
We carried out a prospective observational study to evaluate whether Monocyte Distribution Width (MDW) may play a role in identifying patients with sepsis in comparison with Procalcitonin (PCT). We prospectively enrolled all consecutive patients hospitalized at the Infectious Diseases Unit of Pescara General Hospital for bacterial infection or sepsis. MDW values were collected for all patients. Clinical characteristics, demographic data, past and present medical history, microbiological results, PCT, as well as neutrophil and monocytes indices at entry were compared in the 2 groups. Two-hundred-sixty patients were enrolled, 63.5% males, aged 59.1±19.5 years. Sepsis was diagnosed in 105 (40.4%); in 60 (57.1%) at least 1 microorganism was isolated from blood cultures. In multivariate models, MDW as a continuous variable (OR:1.57 for each unit increase; 95%CI: 1.31–1.87, p<0.001) and PCT˃1 ng/mL (OR: 48.5; 95%CI: 14.7–160.1, p<0.001) were independently associated with sepsis. Statistical best cut points associated with sepsis were 22.0 for MDW and 1.0 ng/mL for PCT whereas MDW values<20 were invariably associated with negative blood cultures. At ROC curve analysis, the AUC of MDW (0.87) was nearly overlapping that of PCT (0.88). Our data suggest that incorporating MDW within current routine WBC counts and indices may be of remarkable use for detection of sepsis. Further research is warranted.
Highlights
Sepsis and septic shock are increasingly reported as a major cause of morbidity and mortality, especially among comorbid and hospitalized patients [1,2]
The Charlson Comorbidity Index (CCI) was calculated for each patient at hospital entry, using criteria defined by Charlson et al (1987) [12,13], including sixteen disease conditions with different weights: Myocardial Infarction, Congestive Heart Failure, Peripheral Vascular disease, Cerebrovascular disease, Dementia, COPD (Chronic Obstructive Pulmonary Disease), Connective Tissue diseases, Peptic Ulcer disease, Diabetes Mellitus, Moderate to severe CKD (Chronic Kidney Disease), Hemiplegia, Leukemia, Malignant Lymphoma, Solid Tumor, Liver disease, AIDS
The aim of our study was to validate the hypothesis that variations in the spread of monocyte size may be an independent predictor of ensuing sepsis in current clinical practice
Summary
Sepsis and septic shock are increasingly reported as a major cause of morbidity and mortality, especially among comorbid and hospitalized patients [1,2]. Survival to septic episodes is significantly improved after early recognition of sepsis and sepsis-related organ dysfunction and early start of appropriate causative and supportive treatment [1,2]. The search for diagnostic tools that may ease diagnosis of sepsis and quick evaluation of sepsisrelated disease severity is intensive, as sepsis is a heterogeneous and elusive condition with. Comparison of MDW and PCT for sepsis recognition
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