Monocyte Distribution Width as a Diagnostic Marker for Infection: A Systematic Review and Meta-analysis

Abstract

Monocyte Distribution Width (MDW) is an emerging biomarker for infection. It is easily and quickly available as part of the complete blood count (CBC), which is routinely performed upon hospital admission. The increasing availability and promising results of MDW as biomarker in sepsis has prompted an expansion of its use to other infectious diseases. What is the diagnostic performance of MDW across multiple infectious disease outcomes and care settings? A systematic review of the diagnostic performance of MDW across multiple infectious disease outcomes was conducted by searching PubMed, EMBASE, Scopus, and Web of Science through February 4th, 2022. Meta-analysis was performed for outcomes with three or more reports identified (sepsis and COVID-19). Diagnostic performance measures were calculated for individual studies with pooled estimates created by linear mixed effects models. We identified 29 studies meeting inclusion criteria. Most examined sepsis (19 studies) and COVID-19 (6 studies). Pooled estimates of diagnostic performance for sepsis differed by reference standard (Sepsis-2 vs Sepsis-3 criteria) and tube anticoagulant used and ranged from an area under the receiver operating characteristic curve (AUC) of 0.74 to 0.94, with mean sensitivity of 0.69 to 0.79 and mean specificity of 0.57 to 0.86. For COVID-19, the pooled AUC of MDW was 0.76, mean sensitivity was 0.79, and mean specificity was 0.59. MDW exhibited good diagnostic performance for sepsis and COVID-19. Diagnostic thresholds for sepsis should be chosen with consideration of reference standard and tube type used. PROSPERO 2022 CRD42020210074.