Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit

Abstract Background Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Inte...

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Autores principales: Ennio Polilli, Antonella Frattari, Jessica Elisabetta Esposito, Andrea Stanziale, Giuliana Giurdanella, Giancarlo Di Iorio, Fabrizio Carinci, Giustino Parruti
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Publicado: BMC 2021
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spelling oai:doaj.org-article:f12de00c9e884dcc8b1de67b70b3e6ed2021-11-28T12:14:15ZMonocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit10.1186/s12873-021-00521-41471-227Xhttps://doaj.org/article/f12de00c9e884dcc8b1de67b70b3e6ed2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12873-021-00521-4https://doaj.org/toc/1471-227XAbstract Background Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit. Methods We performed an observational prospective monocentric study to estimate the analytical performance of MDW in detecting ensuing sepsis in a sample of consecutive patients assisted in an Intensive Care Unit for > 48 h for any reason. Demographic and clinical characteristics, past medical history and other laboratory measurements were included as potential predictors of confirmed sepsis in multivariate logistic regression. Results A total of 211 patients were observed, 129 of whom were included in the final sample due to the suspect of ensuing sepsis; of these, 74 (57%) had a confirmed diagnosis of sepsis, which was best predicted with the combination of MDW > 23.0 and PCT > 0.5 ng/mL (Positive Predictive Value, PPV: 92.6, 95% CI: 82.1–97.9). The best MDW cut-off to rule out sepsis was ≤20.0 (Negative Predictive Value, NPV: 86.4, 95% CI: 65.1–97.1). Multivariate analyses using both MDW and PCT found a significant association for MDW > 23 only (OR:17.64, 95% CI: 5.53–67.91). Conclusion We found that values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV. Our findings suggest that MDW may help clinicians to monitor ICU patients at risk of sepsis, with minimal additional efforts over standard of care.Ennio PolilliAntonella FrattariJessica Elisabetta EspositoAndrea StanzialeGiuliana GiurdanellaGiancarlo Di IorioFabrizio CarinciGiustino ParrutiBMCarticleSepsisMDWProcalcitoninEarly diagnosisIntensive Care UnitSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENBMC Emergency Medicine, Vol 21, Iss 1, Pp 1-11 (2021)
institution DOAJ
collection DOAJ
language EN
topic Sepsis
MDW
Procalcitonin
Early diagnosis
Intensive Care Unit
Special situations and conditions
RC952-1245
Medical emergencies. Critical care. Intensive care. First aid
RC86-88.9
spellingShingle Sepsis
MDW
Procalcitonin
Early diagnosis
Intensive Care Unit
Special situations and conditions
RC952-1245
Medical emergencies. Critical care. Intensive care. First aid
RC86-88.9
Ennio Polilli
Antonella Frattari
Jessica Elisabetta Esposito
Andrea Stanziale
Giuliana Giurdanella
Giancarlo Di Iorio
Fabrizio Carinci
Giustino Parruti
Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
description Abstract Background Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit. Methods We performed an observational prospective monocentric study to estimate the analytical performance of MDW in detecting ensuing sepsis in a sample of consecutive patients assisted in an Intensive Care Unit for > 48 h for any reason. Demographic and clinical characteristics, past medical history and other laboratory measurements were included as potential predictors of confirmed sepsis in multivariate logistic regression. Results A total of 211 patients were observed, 129 of whom were included in the final sample due to the suspect of ensuing sepsis; of these, 74 (57%) had a confirmed diagnosis of sepsis, which was best predicted with the combination of MDW > 23.0 and PCT > 0.5 ng/mL (Positive Predictive Value, PPV: 92.6, 95% CI: 82.1–97.9). The best MDW cut-off to rule out sepsis was ≤20.0 (Negative Predictive Value, NPV: 86.4, 95% CI: 65.1–97.1). Multivariate analyses using both MDW and PCT found a significant association for MDW > 23 only (OR:17.64, 95% CI: 5.53–67.91). Conclusion We found that values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV. Our findings suggest that MDW may help clinicians to monitor ICU patients at risk of sepsis, with minimal additional efforts over standard of care.
format article
author Ennio Polilli
Antonella Frattari
Jessica Elisabetta Esposito
Andrea Stanziale
Giuliana Giurdanella
Giancarlo Di Iorio
Fabrizio Carinci
Giustino Parruti
author_facet Ennio Polilli
Antonella Frattari
Jessica Elisabetta Esposito
Andrea Stanziale
Giuliana Giurdanella
Giancarlo Di Iorio
Fabrizio Carinci
Giustino Parruti
author_sort Ennio Polilli
title Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
title_short Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
title_full Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
title_fullStr Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
title_full_unstemmed Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
title_sort monocyte distribution width (mdw) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit
publisher BMC
publishDate 2021
url https://doaj.org/article/f12de00c9e884dcc8b1de67b70b3e6ed
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