Abstract
Patients in Intensive Care Units (ICU) are a high-risk population for sepsis, recognized as a major cause of admission and death. The aim of the current study was to evaluate the diagnostic accuracy and prognostication of monocyte distribution width (MDW) in sepsis for patients admitted to ICU. Between January and June 2020, we conducted a prospective observational study during the hospitalization of 506 adult patients admitted to the ICU. MDW was evaluated in 2,367 consecutive samples received for routine complete blood counts (CBC) performed once a day and every day during the study. Sepsis was diagnosed according to Sepsis-3 criteria and patients enrolled were classified in the following groups: no sepsis, sepsis and septic shock. MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group [median 26.23 (IQR: 23.48-29.83); 28.97 (IQR: 21.27-37.21); 21.99 (IQR: 19.86-24.36) respectively]. ROC analysis demonstrated that AUC is 0.785 with a sensitivity of 66.88% and specificity of 77.79% at a cut-off point of 24.63. In patients that developed an ICU-acquired sepsis MDW showed an increase from 21.33 [median (IQR: 19.47-21.72)] to 29.19 [median (IQR: 27.46-31.47)]. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19. In sepsis survivors a decrease of MDW values were found from the first time to the end of their stay [median from 29.14 (IQR: 26.22-32.52) to 25.67 (IQR: 22.93-30.28)]. In ICU, MDW enhances the sepsis detection and is related to disease severity.
Highlights
Most current automated hematology analyzers have enhanced cell counting functions including the addition of new cell types such as nucleated red blood cells or immature granulocytes, making it possible to obtain a precise quantification of peripheral blood cells in pathological conditions
The aim of the present study is to evaluate the clinical usefulness of the monocyte distribution width (MDW) using the UniCel DxH 900 Beckman Coulter hematology analyzer, to early identify patients with sepsis or that became septic during their stay in Intensive Care Units (ICU)
The inclusion criteria were: adult (>18 years) patients presenting to the ICU, who remained hospitalized for at least 24 h, enrolled no more than once, with a complete blood counts (CBC) and differential testing performed at presentation and over the entire course of the length of stay (LOS), as part of standard medical care and PCT or C-reactive protein (CRP) tests ordered at the same time
Summary
Most current automated hematology analyzers have enhanced cell counting functions including the addition of new cell types such as nucleated red blood cells or immature granulocytes, making it possible to obtain a precise quantification of peripheral blood cells in pathological conditions. Besides the new quantitative assessment, cellular analysis technologies are able to explore qualitative aspects of leukocytes (white blood cells, WBCs) and provide numerous additional parameters, indicating functional information for each leukocyte type, the socalled cell population data (CPD). CPD provide useful information on the basis of several cell proprieties such as volume characteristics, conductivity due to cytoplasm features, and various light‐scattering patterns, reflecting different distribution of cells due to change in size, intracellular components and/or structure. These parameters can represent the morphological reactions of the cells to various environmental factors [1, 2]. The ESId evaluates the width of monocyte volumes (Monocyte Distribution Width, MDW) and the novel parameter can be reported alongside routine cell blood count (CBC) and differential as an optional add-on feature
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