Biomedicine

Abstract

Introduction & Aim: Sepsis is a global public health issue with high morbidity and mortality. Early detection is a key healthcare objective, with biomarkers playing a vital role in improving patient outcomes. Monocyte distribution width (MDW), a quantitative morphological parameter in the Unicel DxH900 (Beckman Coulter) is easily and quickly available as part of the complete blood count (CBC). This study aimed to validate the utility of MDW for diagnosis and management of sepsis. Materials and Methods: This study included all patients >18 years of age, presenting to the Emergency Department and those admitted to the Intensive Care Units for a period of 3 months. Patient diagnosis, CBC with MDW, CRP, PCT, serum lactate values, and blood culture reports were retrieved from the hospital information software. Results: 1633 patients were enrolled in this study. They were categorized as non-infection (61%), infection without sepsis (31%), sepsis (4%) and septic shock (4%) using Sepsis-3 criteria. MDW had a sensitivity of 77.6% and specificity of 77.7% at a cut-off of 22.75 (established using ROC curve at a significant p-value of <0.05) in detecting sepsis in both ED and ICU patients. It outperformed all other sepsis parameters such as CRP (sensitivity-63.2% and specificity-63.6%).), PCT (sensitivity-70.6% and specificity-71%).), NLR (sensitivity-62.4% and specificity-62.5%).) and serum lactate(sensitivity-60.6% and specificity-60.1%). The combined sensitivity of MDW and NLR was 97.6% with a negative predictive value of 99.5%. Conclusion: Integrating MDW with existing diagnostic practices could enhance early sepsis detection and improve patient management strategies. Sepsis can be excluded with high reliability when the MDW value is below the cut-off and more so when used in conjunction with NLR.