Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit

Ennio Polilli,Giustino Parruti,Antonella Frattari,Fabrizio Carinci,Giuliana Giurdanella,Giancarlo Di Iorio,Jessica Elisabetta Esposito,Andrea Stanziale

doi:10.1186/s12873-021-00521-4

Ennio Polilli, Giustino Parruti + Show 6 more

Open Access

https://doi.org/10.1186/s12873-021-00521-4

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Abstract

BackgroundMonocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit.MethodsWe performed an observational prospective monocentric study to estimate the analytical performance of MDW in detecting ensuing sepsis in a sample of consecutive patients assisted in an Intensive Care Unit for > 48 h for any reason. Demographic and clinical characteristics, past medical history and other laboratory measurements were included as potential predictors of confirmed sepsis in multivariate logistic regression.ResultsA total of 211 patients were observed, 129 of whom were included in the final sample due to the suspect of ensuing sepsis; of these, 74 (57%) had a confirmed diagnosis of sepsis, which was best predicted with the combination of MDW > 23.0 and PCT > 0.5 ng/mL (Positive Predictive Value, PPV: 92.6, 95% CI: 82.1–97.9). The best MDW cut-off to rule out sepsis was ≤20.0 (Negative Predictive Value, NPV: 86.4, 95% CI: 65.1–97.1). Multivariate analyses using both MDW and PCT found a significant association for MDW > 23 only (OR:17.64, 95% CI: 5.53–67.91).ConclusionWe found that values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV. Our findings suggest that MDW may help clinicians to monitor ICU patients at risk of sepsis, with minimal additional efforts over standard of care.

Highlights

Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin
We present the results of a targeted investigation aimed at testing the use of MDW in association with serial PCT measurements, to identify a new algorithm for the early detection of sepsis in patients hospitalised at the Intensive Care Unit (ICU) for any reason
CCI Charlson Comorbidity Index, SAPS Simplified Acute Physiology Score, SOFA Sequential Organ Failure Assessment, PCT Procalcitonin; CRP: C-Reactive Protein; MDW Monocyte Distribution Width, WBC White Blood Cell Count; †at ICU admission; ††at sepsis diagnosis, available for 58 patients mL (0.80; 95% CI: 0.74–0.87)

Summary

Introduction

Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit. 5 to 10% of patients with sepsis are directly hospitalized at an Intensive Care Unit (ICU) for septic shock, while 8–10% of those admitted at the ICU are at risk of developing either condition during their hospital stay [1,2,3,4]. Procalcitonin (PCT) is acknowledged as the single best parameter for patients at the ICU [6,7,8]. Even with serial PCT measurements, the level of sensitivity and specificity achieved for the prediction of sepsis was at best equal to 75% [11, 12]. Specific limitations, including the impact of renal function and immune status on physiological variations of presepsin levels, made both standardization and scaling up of presepsin quite difficult [14]

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