Diagnostic Utility of Monocyte Distribution Width (MDW) in Early Diagnosis of Sepsis - Beyond SOFA and SIRS

Résumé fourni par la source

Background: Sepsis remains a critical challenge due to high mortality and the limitations of traditional diagnostics, which are often slow (microbial culture) or lack specificity (CRP and Pro-calcitonin). Monocyte Distribution Width (MDW), an automated haematology cell analyzer generated parameter quantifying monocyte size variation, reflects early immune cell activation and cellular swelling (pyroptosis) during systemic infection. This study evaluated the diagnostic accuracy of MDW for early sepsis detection. Methods: This hospital-based cross-sectional study included 153 adult intensive care unit (ICU) patients with clinical suspicion of sepsis and 100 healthy controls. Blood samples were collected at the time of clinical suspicion of sepsis for complete blood count, microbial culture, CRP and Pro-calcitonin. MDW was measured using Beckman Coulter Unicel DxH 900 analyzer. Diagnostic performance was evaluated using Area under the Curve (AUC), optimal cutoff determination, and correlation analysis against other biomarkers and the microbial culture gold standard. Results: 104 patients were microbial culture-positive. Mean MDW was found to be significantly higher in culture-positive cases (26.35 ± 6.18) compared to culture-negative cases (17.79 ±1.69) and controls (16.27 ± 1.26) (p< 0.001). MDW showed excellent diagnostic performance (AUC = 0.969) with an optimal cut off of 20.655, achieving 90.4% sensitivity and 98.0%specificity. MDW demonstrated a strong positive correlation with CRP (r=0.597). Conclusion: Monocyte Distribution Width is a reliable, rapid, and highly accurate early biomarker for sepsis, demonstrating almost perfect agreement with microbial culture (Kappa=0.843). As it is available from a standard complete blood count, integrating MDW into the initial laboratory workup can significantly enhance the speed and accuracy of sepsis diagnosis in the ICU. Key words: Sepsis, Monocyte Distribution Width, Hematology Analyser, Pro-calcitonin, C-reactive protein

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