Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Figures & data

Table 1 Researches About Monocyte Distribution Width (MDW) and Sepsis

Study Period	Design Method	Country	Participants	Department	Criteria	Cutoff of MDW (U)	Anticoagulants	Other Indicators	Main Findings	References
September to November 2019	Prospective	Italy	Control (1855), infection (172), SIRS (100), sepsis (88)	ED	Sepsis-2	23.5	K3EDTA	CRP, WBC, qSOFA, blood culture, use of antibiotics	MDW levels were higher in patients with sepsis than in all other groups (p < 0.001)	[31]
	Prospective	Italy	Suspected COVID-19 patients (147)	ED		20	K2EDTA		The MDW of hospitalized patients in intensive care unit was significantly higher than that of patients with moderate and low symptoms	[63]
June 19, 2017 to January 26, 2018	Retrospective	USA	Adults (2158)	ED	Sepsis-2 Sepsis-3			qSOFA, SIRS, WBC	MDW improves the detection rate of sepsis in the ED and is a good supplementary parameter for SIRS and qSOFA	[33]
	Prospective	USA	Control (879), SIRS (203), infection (140), sepsis (98)	ED	Sepsis-2	20.5		MNV, NDW, MMV	MDW combined with WBC can increase the detection rate of sepsis	[30]
April 2017 to January 2018	Prospective	USA	Adults (2158)	ED	Sepsis-2 Sepsis-3	20		WBC	MDW value of greater than 20.0 U is effective for sepsis detection, during the initial ED encounter	[35]
Part 1: March 11, to April 5, 2020 Part 2: April 6, to April 13, 2020	Part 1: Retrospective Part 2: Prospective	France	Part 1: Control (137), COVID-19+ (322), COVID-19− (285) Part 2: Suspected COVID-19 patients (222)	ED		21.71	K3EDTA	CPD, CRP	CPD (including MDW) can improve the diagnostic efficiency of patients with COVID-19, and false-positive results are common in sepsis	[67]
February 19, to April 30, 2020	Retrospective	China	Respiratory infection (174)	ED		20		NLR	MDW and NLR can distinguish COVID-19 from influenza and upper respiratory tract infections	[66]
October to November 2020	Retrospective	Italy	control (498), infection (105), SIRS (52) and sepsis (48)	ED	Sepsis-2		K3EDTA	MMV	Compared with MDW alone, monocyte index SI (based on MDW and MMV) showed increased specificity, positive predictive value, and positive likelihood ratio	[28]
August 2, 2018, to June 27, 2019	Prospective	France, Spain	Adults (1517)	ED	Sepsis-2 Sepsis-3	21.5	K3EDTA	PCT, CRP	MDW in combination with WBC has the diagnostic accuracy to detect sepsis, and the diagnostic efficiency is equivalent to CRP and superior to PCT	[38]
January 1, 2020 to November 30, 2020	Retrospective	China	Sepsis (296), no sepsis (1184)	ED	Sepsis-2	20		CRP, NLR, PLR, qSOFA	MDW, NLR, and PLR can be used for the early detection of sepsis in the current sepsis scoring systems	[36]
September 2019 to March 2020	Prospective	Italy	Adults (2297)	ED ICU	Sepsis-2 (ED) Sepsis-3 (ICU)	23	K3EDTA	CRP, PCT	MDW has good diagnostic efficiency for sepsis, and the cutoff value of MDW is determined to be 23	[71]
January to June 2020	Prospective	Italy	Adults (506) (no sepsis, sepsis, septic shock)	ICU	Sepsis-3	24.63	K2EDTA	PCT, CRP	MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19	[42]
September 2019 to March 2020	Prospective	Italy	No sepsis (50), developing sepsis during hospital stay (16), sepsis (30)	ICU	Sepsis-3		K3EDTA	CRP, PCT	Patients with sepsis had significantly increased MDW, a reliable sepsis marker in the ICU	[40]
January 1, to December 31, 2018	Prospective	Italy	ICU patients (211)	ICU	Sepsis-3	20	K3EDTA	PCT	Values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV	[41]
August 2017 to September 2018	Prospective	Italy	Suspected infection or sepsis (310)	Infectious Diseases Unit	Sepsis-3	22.0	K3EDTA	PCT	Incorporating MDW into current leukocyte techniques can significantly improve the detection of sepsis	[69]
July 2010 to February 2012	Prospective	Turkey	Newborns (227)					MNV, MMV, MNC, MMC MNS, MMS, NDW, CRP, PCT IL-6	MDW was higher in infants with sepsis than in controls, and in the diagnosis of neonatal sepsis was lower than that of CRP, PC and IL-6	[49]
April to September 2016	Retrospective	Korea	Pediatric patients (232)			22		WBC, DN, NDW, MPV, PDW, PMDW, IPF, CRP, PCT	WBC, DN, NDW, MDW, MPV, PDW, PMDW, and IPF were valuable markers for predicting mortality	[50]
February 14 to February 29, 2020	Retrospective	China	Suspected COVID-19 patients (147)			20.1		MNV, NDW, MMV MLV, LDW, Lymph index	MDW and lymphoid index in patients with COVID-19 were significantly higher than those in control group, and MDW and lymphoid index had good diagnostic performance for patients with COVID-19	[64]
April to June 2020	Retrospective	Italy	COVID-19 patients (87)			26.4 (threshold)	K2EDTA	CRP, fibrinogen, ferritin	MDW was significantly correlated with CRP, fibrinogen and ferritin. High MDW values are associated with prognosis and death outcomes in COVID-19 patients	[68]

Abbreviations: ED, emergency department; ICU, intensive care unit; SIRS, systemic inflammatory response syndrome; EDTA, ethylenediaminetetraacetic acid; CRP, C-reactive protein; WBC, white blood cell; qSOFA, Quick Sequential (Sepsis Related) Organ Failure Assessment Score; CPD, cellular population data; PCT, procalcitonin. NDW, neutrophil distribution width; MNV, mean neutrophil volume; MNC, mean neutrophil conductivity; MNS, mean neutrophil scattering; DN, neutrophil index; MMV, mean monocyte volume; MMC, mean monocyte conductivity; MMS, mean monocyte scattering; MPV, mean platelet volume; PDW, platelet distribution width; MPC, mean platelet component; PCDW, platelet component distribution width; MPM, mean platelet mass; PMDW, platelet mass distribution width; IPF, immature platelet fraction; MLV, mean lymphocyte volume; LDW, lymphocyte distribution width; Lymph index, MLV* LDW/LC (lymphocyte conductivity); NPV, negative predictive value; PPV, positive predictive value.

Figure 1 MDW and the role of MDW in various diseases. The morphological changes of monocytes can be indicated by MDW values. Under the action of various stimuli, monocytes undergo morphological changes, which can reflect the state of host immune function and the state and process of disease.

Abbreviations: PAMPs, pathogen-associated molecular patterns; DAMPs, damage associated molecular patterns; Mtb, mycobacterium tuberculosis; RA, rheumatoid arthritis.

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