Author(s): Shano Naseem, Neelam Varma, Ishwar Bihana, Praveen Sharma, Brijesh Verma, Sanjeev Kumar, Navneet Sharma, Pallab Ray, Shivaprakash M Rudramurthy, RK Ratho, Sandhya Bastian, Elena Sukhacheva
INTRODUCTION Early sepsis identification is vital to give specific treatment. Biomarkers for Sepsis have been studied however, none are specific. This study, Monocyte Distribution Width (MDW) was evaluated as a biomarker for sepsis and infection detection.
METHODS 356 adult patients presented to the emergency department with suspected infection or Sepsis, in whom a complete blood count with differential leucocyte count was performed, were included in the study. Patients were classified into diagnostic groups with sepsis - 2 and sepsis - 3 criteria. MDW was evaluated on the Beckman Coulter DxH 900 hematology analyser. MedCalc was used for statistical analysis to calculate Area Under the Curve (AUC), Positive Predictive Value (PPV), Negative Predictive Value (NPV), sensitivity, specificity, and the positive and negative likelihood ratio for MDW as a biomarker of sepsis / infection.
RESULTS MDW values correlated with the severity of infection increased from no infection group to infection, sepsis, and septic shock. For sepsis - 2 detection, MDW demonstrated AUC 0.746, sensitivity of 81.48 %, and specificity of 59.27 % at cut off > 22.48. For infection detection with sepsis - 3 definitions, MDW demonstrated AUC 0.752, sensitivity of 73.08 %, specificity of 66.67 at cutoff > 23.02. MDW performance was similar in subgroups of patients with and without immunosuppression. In patients with 1 or 2 SIRS, sepsis probability increased 4.7 times if MDW was abnormal compared to normal; in the whole cohort, sepsis probability increased 7 times if MDW was abnormal. MDW, together with White Blood Cell Counts (WBC), showed 100 % sensitivity and NPV for sepsis - 2 identification, if either of them was abnormal.
CONCLUSION MDW correlated with the severity of infection showed high NPV and sensitivity for sepsis - 2 detection. As complete blood counts with differential leucocyte counts are a part of routine workup in all patients, MDW can be considered a useful sepsis biomarker.