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Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit

  • Luisa Agnello , Anna Maria Ciaccio , Fabio Del Ben ORCID logo , Bruna Lo Sasso , Giuseppe Biundo , Aurora Giglia , Rosaria Vincenza Giglio , Andrea Cortegiani , Caterina Maria Gambino and Marcello Ciaccio EMAIL logo
Published/Copyright: April 22, 2024
Diagnosis
From the journal Diagnosis Volume 11 Issue 4

Abstract

Objectives

Monocyte distribution width (MDW) is a measure of monocyte anisocytosis. In this study, we assessed the role of MDW, in comparison to C-reactive protein (CRP), procalcitonin (PCT), and lactate, as a screening and prognostic biomarker of sepsis in intensive care unit (ICU) by longitudinally measuring it in the first 5 days of hospital stay.

Methods

We considered all consecutive patients admitted to the ICU. At admission, patients were classified as septic or not according to Sepsis-3 criteria. MDW, CRP, PCT, and lactate were measured daily in the first 5 days of hospitalization. ICU mortality was also recorded.

Results

We included 193 patients, 62 with sepsis and 131 without sepsis (controls). 58% and 26 % of the patients, with and without sepsis respectively, died during ICU stay. MDW showed the highest accuracy for sepsis detection, superior to CRP, PCT, and lactate (AUC of 0.840, 0.755, 0.708, 0.622, respectively). At admission, no biomarker predicts ICU mortality in patients with sepsis. The kinetic of all biomarkers during the first 5 days of hospitalization was associated with ICU mortality. Noteworthy, above all, the kinetic of MDW showed the best accuracy. Specifically, an increase or decrease in MDW from day 1–4 and 5 was significantly associated with mortality or survival, respectively.

Conclusions

MDW is a reliable diagnostic and prognostic sepsis biomarker, better than traditional biomarkers.

Keywords: MDW; sepsis; biomarker; prognosis; diagnosis; kinetic
Corresponding author: Professor Marcello Ciaccio, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine, and Clinical Laboratory Medicine, University of Palermo, Palermo 90127, Italy; and Department of Laboratory Medicine, University Hospital “P. Giaccone”, Palermo 90127, Italy, E-mail:
Luisa Agnello and Anna Maria Ciaccio contributed equally to this work.

  1. Research ethics: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by Authors’ Institutional Review Board (nr 07/2019).

  2. Informed consent: Informed consent was not required because we did not perform additional biochemical analysis. Confidentiality was guaranteed and no interventions were performed beyond ordinary good and standard clinical practices.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: Authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2024-0019).

Received: 2024-01-23
Accepted: 2024-04-08
Published Online: 2024-04-22
Published in Print: 2024-11-26

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2024-0019
Keywords for this article
MDW; sepsis; biomarker; prognosis; diagnosis; kinetic

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Should APTT become part of thrombophilia screening?
  4. Review
  5. n-3 fatty acids and the risk of atrial fibrillation, review
  6. Guidelines and Recommendations
  7. Root cause analysis of cases involving diagnosis
  8. Opinion Papers
  9. What is diagnostic safety? A review of safety science paradigms and rethinking paths to improving diagnosis
  10. Interprofessional clinical reasoning education
  11. Original Articles
  12. Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area
  13. Typology of solutions addressing diagnostic disparities: gaps and opportunities
  14. Diagnostic errors and characteristics of patients seen at a general internal medicine outpatient clinic with a referral for diagnosis
  15. Cost-benefit considerations of the biased diagnostician
  16. Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study
  17. Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit
  18. Are shortened aPTT values always to be attributed only to preanalytical problems?
  19. External Quality Assessment (EQA) scheme for serological diagnostic test for SARS-CoV-2 detection in Sicily Region (Italy), in the period 2020–2022
  20. Recent mortality rates due to complications of medical and surgical care in the US
  21. Short Communication
  22. The potential, limitations, and future of diagnostics enhanced by generative artificial intelligence
  23. Case Report – Lessons in Clinical Reasoning
  24. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership
  25. Letters to the Editor
  26. The ‘curse of knowledge’: when medical expertise can sometimes be a liability
  27. A new approach for identifying innate immune defects
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