Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining Association With Early Sepsis

The Role of Monocyte Distribution Width (MDW) in the Prediction of Death in Adult Patients with Sepsis

Sepsis is a life-threatening condition; it is a major cause of hospital mortality worldwide and it constitutes a global health problem. This research investigates the use of MDW as a predictor for septic patients. This was a double-center prospective cohort study of adult septic patients. Septic patients were identified and were categorized into two categories: those who improved and those who died. Blood was drawn from the patients three times, on the first, third, and fifth day of their admission to the hospital. MDW was evaluated as a biomarker to predict patient outcome. In addition, existing inflammatory markers were recorded in all patients. The MDW was able to predict patient's outcome. The average MDW was found to be significantly higher in patients who died in all records. For example, an MDW value of 28.4 on the first day of admission to the hospital was shown to be the best cut-off value in determining fatal outcomes; receiver operating characteristic (ROC) analysis revealed an area under the curve value of 0.71 (95% Confidence Interval-CI: 0.57-0.84) with a sensitivity of 64.7% and a specificity of 88.2%. In conclusion, MDW, in addition to being a marker that can quickly detect sepsis more effectively than other biomarkers, which is proven by numerous studies, could also be used as an indicator to predict patient outcome. This work is an attempt in that direction.

The Diagnostic Value of Neutrophil and Monocyte Cell Population Data Obtained From a Hematology Analyzer in Neonatal Sepsis

We aimed to investigate the diagnostic value of leukocyte cell population data (CPD) parameters obtained from an automated hematology analyzer to be able to use it in the diagnosis of neonatal sepsis. Our study was a retrospective and cross-sectional analysis. The neonates were classified into 3 groups: culture-positive sepsis (n = 20), clinical sepsis (n = 87), and control (n = 269). CPD parameters were determined during complete blood count (CBC) by volume-conductivity-scatter (VCS) technology with DxH 900 Coulter Cell Analyzer. Mean neutrophil volume (MNVNE), standard deviations of volumes of neutrophils (SDVNE), standard deviations of volumes of monocytes (SDVMO), and monocyte distribution width (MDW) were significantly increased in the culture-positive sepsis group compared with the clinical sepsis and control groups (P < .05). We have demonstrated the diagnostic utility of leukocyte CPD parameters, especially MNVNE, MDW, and their combination, for neonatal sepsis. These parameters are advantageous because they are obtained during routine CBC analysis without the need for additional blood collection and extra costs.

Machine learning interpretability methods to characterize the importance of hematologic biomarkers in prognosticating patients with suspected infection

OBJECTIVE

To evaluate the effectiveness of Monocyte Distribution Width (MDW) in predicting sepsis outcomes in emergency department (ED) patients compared to other hematologic parameters and vital signs, and to determine whether routine parameters could substitute MDW in machine learning models.

METHODS

We conducted a retrospective analysis of data from 10,229 ED patients admitted to a large regional safety-net hospital in Cleveland, Ohio who had suspected infections and developed sepsis-associated poor outcomes. We developed a new analytical framework consisting of seven data models and an ensemble of high accuracy machine learning (ML) algorithms (accuracy values ranging from 0.83 to 0.90) to predict sepsis-associated poor outcomes (3-day intensive care unit stay or death). Local Interpretable Model-Agnostic Explanation (LIME) and Shapley Additive Value (SHAP) interpretability methods were utilized to assess the contributions of individual hematologic parameters.

RESULTS

The ML interpretability analysis indicated that the predictive value of MDW is significantly reduced when other hematological parameters and vital signs are considered. The results suggest that complete blood count with differential (CBD-DIFF) alongside vital signs can effectively replace MDW in high accuracy machine learning algorithms for screening poor outcome associated with sepsis.

CONCLUSION

MDW, although a newly approved biomarker for sepsis, does not significantly enhance prediction models when combined with routinely available parameters and vital signs. Hospitals, especially those with resource constraints, can rely on existing parameters with high accuracy machine learning models to predict sepsis outcomes effectively, thereby reducing the need for specialized tests like MDW.

Deciphering the role of monocyte and monocyte distribution width (MDW) in COVID-19: an updated systematic review and meta-analysis

The SARS-CoV-2 infection is characterized by both systemic and organ hyper-thromboinflammation, with a clinical course ranging from mild up-to critical systemic dysfunction and death. In patients with coronavirus disease 2019 (COVID-19) the monocyte/macrophage population is deeply involved as both trigger and target, assuming the value of useful diagnostic/prognostic marker of innate cellular immunity. Several studies correlated morphological and immunophenotypic alterations of circulating monocytes with clinical outcomes in COVID-19 patients, concluding that monocyte distribution width (MDW) may retain clinical value in stratifying the risk of disease worsening. Through an electronic search in Medline and Scopus we performed an updated literature review and meta-analysis aimed to explore the association between increased MDW levels and illness severity in COVID-19 patients, deciphering role(s) and function(s) of monocytes in the harmful network underlining SARS-CoV-2 infection. We found that significantly elevated MDW values were frequently present in COVID-19 patients who developed unfavorable clinical outcomes, compounded by a significant association between monocyte anisocytosis and SARS-CoV-2 outcomes. These findings suggest that blood MDW index and its scatter plot could represent useful routine laboratory tools for early identification of patients at higher risk of unfavorable COVID-19 and for monitoring the progression of viral infection, clinical outcomes, and therapeutic efficacy throughout hospitalization. According to this evidence, therapeutic decisions in patients with SARS-CoV-2 infection could benefit from monitoring MDW value, with administration of drugs limiting thrombo-inflammation due to monocyte hyper-activation in patients with severe/critical COVID-19 disease.