Monocyte distribution width may help in early diagnosis of sepsis

A new study published in BMC Infectious Diseases suggests that with little additional work on the routine practices used during emergency treatment, including monocyte Distribution Width (MDW) in the clinical decision process may increase the early detection of sepsis.

A straight forward cellular indicator of innate monocyte activation called monocyte distribution width can be used to detect sepsis early. In order to evaluate the predictive value of MDW in detecting sepsis in a sample of consecutive patients presenting at the Emergency Department, Ennio Polilli and colleagues conducted an observational prospective monocentric study.

Multivariate logistic regression is used in this prospective observational study together with demographic, clinical, and previous medical history data to predict confirmed sepsis.

The key findings of this study were:

1. The trial comprised 2724 patients, with 272 (10%) suffering from sepsis or septic shock.

2. After controlling for known and potential risk factors, logistic regression identified the following independent predictors of sepsis: SIRS equal to 1 (OR: 2.32, 1.16-4.89) and 2 or more (OR: 27.8, 14.8-56.4), MDW > 22 (OR: 3.73, 2.46-570), smoking (OR: 3.0, 1.22-7.31), end stage renal function (OR: 2.3, 1.25-4.22), neurodegenerative disease (OR: 2.2, 1.31-3 (OR: 2.57, 1.63–4.08), CRP ≥ 19.1 mg/L (OR: 2.57, 1.63–4.08), Lymphocytes < 1.3 × 103/µL (OR: 1.72, 1.17–2.53) and Neutrophils ≥ 8.9 × 103/µL (OR: 2.73, 1.82–4.11).

3. Using an optimum threshold, a risk score produced from predictive models exhibited great accuracy (AUC: 95%; 93-97%).

Researchers found clinical and laboratory markers related with a sepsis diagnosis in a population referred to an ED of a large regional hospital in this investigation. A score of MDW 22 was related with a nearly threefold higher risk of sepsis among clinical and laboratory factors. Based on the early examination of personal features at the ED, risk ratings obtained from multivariate models demonstrated moderate to high prediction accuracy in detecting people with sepsis.

The findings imply that adding MDW into clinical decision making may enhance early detection of sepsis in the ED while requiring little additional effort above and beyond normal procedures. More multicentric research is needed to corroborate our findings.

Reference:

Polilli, E., Di Iorio, G., Silveri, C., Angelini, G., Anelli, M. C., Esposito, J. E., D'Amato, M., Parruti, G., & Carinci, F. (2022). Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department. In BMC Infectious Diseases (Vol. 22, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12879-022-07803-7