Diagnostic and Prognostic Value of Monocyte Distribution Width in Sepsis

Monocyte distribution width (MDW) as a reliable diagnostic biomarker for sepsis in patients with HIV

Sepsis is a leading cause of death among patients with HIV, but early diagnosis remains a challenge. This study evaluates the diagnostic performance of monocyte distribution width (MDW) in detecting sepsis in patients with HIV. A prospective observational study was conducted at Shanghai Public Health Center, involving 488 hospitalized patients with HIV aged 18-65 between December 2022 and August 2023. MDW was measured at admission, and its diagnostic accuracy was compared with Sepsis-3 criteria. Survival rates on day 28 and 90 were also recorded. Additionally, five machine learning (ML) models were tested to enhance diagnostic efficacy. Of 488 subjects, 90 were in the sepsis group and 398 in the control group. MDW showed a diagnostic area under the curve (AUC) of 0.82, comparable to C-reactive protein (CRP) and Procalcitonin (PCT) with AUCs of 0.78 and 0.82, respectively. With a cut-off value of 25.25, MDW had a sensitivity of 0.83 and specificity of 0.76. The positive and negative predictive values were 44% and 95%, respectively. When MDW was combined with platelet count, serum albumin, and hemoglobin in a random forest model, the AUC improved to 0.931. The model achieved a sensitivity of 1.00 and specificity of 0.732. MDW is a useful diagnostic marker for sepsis in patients with HIV, with strong sensitivity and specificity. Combining MDW with other lab markers can further enhance diagnostic accuracy.Trial registration: ClinicalTrials.gov identifier: NCT05036928..

Intensive Care Infection Score (ICIS) is an Early Marker for Infection in Time of Admission to Intensive Care Units

BACKGROUND

Despite all the effort, infections remain one of the major causes of morbidity and mortality in clinically ill patients, and novel diagnostic markers detecting infections in early stages are searched for. Intensive Care Infection Score (ICIS) was developed as such a marker.

METHODS

A total of 102 patients admitted to intensive care units (ICU) in the University Hospital Hradec Kralove, Czech Republic were enrolled in this study. ICIS along with relevant biochemical markers (procalcitonin, C-reactive protein and Interleukin 6) was analyzed on the day of the admission. Individual parameters used to calculate ICIS were analyzed too. Infection was subsequently confirmed in 30 patients.

RESULTS

ICIS predicted infections with the highest AUC (0.958) of all analyzed markers. The cut-off value (< 4) was selected as the value with the highest Youden index, and it predicted sepsis with high specificity (84.2%) and sensitivity (93.3%). Negative predictive value was very high too (96.8%). Positive predictive value was 71.8%.

CONCLUSIONS

ICIS is a reliable, cheap, fast, and simply interpretable score for the early identification of infection in patients admitted to ICUs. ICIS ≥ 4 predicts infection with high sensitivity, specificity, and negative predictive value.

Efficacy of monocyte distribution width in predicting critical illness in patients with COVID-19 pneumonia: a retrospective cohort study

BACKGROUND

Identifying patients at a risk of severe COVID-19 is crucial for prompt intervention and mortality risk mitigation. The monocyte distribution width (MDW) is an effective accurate predictor of sepsis in emergency settings, facilitating timely patient management. However, few reliable laboratory parameters are available for predicting the severity and prognosis of COVID-19. Thus, this study was conducted to investigate whether MDW can accurately predict the severity and progression of COVID-19 pneumonia.

METHODS

This retrospective cohort study included patients with COVID-19 pneumonia who had been admitted to our hospital between January 1, 2022, and September 31, 2022. The primary outcome was the development of critical illness, which was assessed in terms of intensive care unit (ICU) admission, need for mechanical ventilation (MV), or mortality. The secondary outcomes were durations of ICU stay, MV, and hospital stay. Multivariate logistic regression was performed to estimate the risks of critical illness and mortality.

RESULTS

Data from 878 patients with COVID-19 were analyzed. Of these, 258 (29.4%) developed critical illness. The high-MDW group (MDW > 22) showed a higher rate of critical illness (155/452, 34.29%) compared to the low-MDW group (103/426, 24.18%). Mortality was also higher in the high-MDW group (95/452, 21.02%) than in the low-MDW group (37/426, 8.69%). Patients with MDW > 22 exhibited a significantly higher risk of developing critical illness (adjusted odds ratio [aOR]: 1.48; 95% confidence interval [CI]: 1.08-2.04) and mortality (aOR: 2.46; 95% CI: 1.63-3.74) compared to those with MDW ≤ 22.

CONCLUSION

Our findings suggest that an elevated MDW value at presentation may serve as a promising predictor of severe outcomes in patients with COVID-19 pneumonia. This underscores the need for further research to validate the utility of MDW in predicting critical illness among patients with viral pneumonia.

Macropolycytes as a sepsis biomarker

A 16-year-old male patient who underwent a kidney transplant developed a septic shock. A full blood count (FBC) was performed and the presence of monocytosis in the automatic FBC, the overlap between neutrophils and monocytes in the WBC scatter plot, and a "MO blast" flag triggered by the analyzer, led to a peripheral blood film (PBF). PBF revealed the presence of macropolycytes that were erroneously count as monocytes by the analyzer. Macropolycytes can play an important role as a sepsis biomarker.

Complete Blood Count and Monocyte Distribution Width-Based Machine Learning Algorithms for Sepsis Detection: Multicentric Development and External Validation Study

BACKGROUND

Sepsis is an organ dysfunction caused by a dysregulated host response to infection. Early detection is fundamental to improving the patient outcome. Laboratory medicine can play a crucial role by providing biomarkers whose alteration can be detected before the onset of clinical signs and symptoms. In particular, the relevance of monocyte distribution width (MDW) as a sepsis biomarker has emerged in the previous decade. However, despite encouraging results, MDW has poor sensitivity and positive predictive value when compared to other biomarkers.

OBJECTIVE

This study aims to investigate the use of machine learning (ML) to overcome the limitations mentioned earlier by combining different parameters and therefore improving sepsis detection. However, making ML models function in clinical practice may be problematic, as their performance may suffer when deployed in contexts other than the research environment. In fact, even widely used commercially available models have been demonstrated to generalize poorly in out-of-distribution scenarios.

METHODS

In this multicentric study, we developed ML models whose intended use is the early detection of sepsis on the basis of MDW and complete blood count parameters. In total, data from 6 patient cohorts (encompassing 5344 patients) collected at 5 different Italian hospitals were used to train and externally validate ML models. The models were trained on a patient cohort encompassing patients enrolled at the emergency department, and it was externally validated on 5 different cohorts encompassing patients enrolled at both the emergency department and the intensive care unit. The cohorts were selected to exhibit a variety of data distribution shifts compared to the training set, including label, covariate, and missing data shifts, enabling a conservative validation of the developed models. To improve generalizability and robustness to different types of distribution shifts, the developed ML models combine traditional methodologies with advanced techniques inspired by controllable artificial intelligence (AI), namely cautious classification, which gives the ML models the ability to abstain from making predictions, and explainable AI, which provides health operators with useful information about the models' functioning.

RESULTS

The developed models achieved good performance on the internal validation (area under the receiver operating characteristic curve between 0.91 and 0.98), as well as consistent generalization performance across the external validation datasets (area under the receiver operating characteristic curve between 0.75 and 0.95), outperforming baseline biomarkers and state-of-the-art ML models for sepsis detection. Controllable AI techniques were further able to improve performance and were used to derive an interpretable set of diagnostic rules.

CONCLUSIONS

Our findings demonstrate how controllable AI approaches based on complete blood count and MDW may be used for the early detection of sepsis while also demonstrating how the proposed methodology can be used to develop ML models that are more resistant to different types of data distribution shifts.

The Need for Standardized Guidelines for the Use of Monocyte Distribution Width (MDW) in the Early Diagnosis of Sepsis

Sepsis is a complex and potentially life-threatening syndrome characterized by an abnormal immune response to an infection, which can lead to organ dysfunction, septic shock, and death. Early diagnosis is crucial to improving prognosis and reducing hospital management costs. This narrative review aims to summarize and evaluate the current literature on the role of monocyte distribution width (MDW) as a diagnostic biomarker for sepsis, highlighting its advantages, limitations, and potential clinical applications. MDW measures the volumetric distribution width of monocytes, reflecting monocytic anisocytosis, and is detected using advanced hematological analyzers. In 2019, it was approved by the FDA as a biomarker for sepsis due to its ability to identify systemic inflammatory response at an early stage. Thirty-one studies analyzed by us have shown that an increased MDW value is associated with a higher risk of sepsis and that its combination with clinical parameters (such as qSOFA) and other biomarkers (CRP, PCT) can enhance diagnostic sensitivity and risk stratification capacity. Despite its high sensitivity, MDW has lower specificity compared to more established biomarkers such as procalcitonin, thus requiring a multimodal integration for an accurate diagnosis. The use of MDW in emergency and intensive care settings represents an opportunity to improve early sepsis diagnosis and critical patient management, particularly when combined with other markers and clinical tools. However, further studies are needed to define a universal cut-off and confirm its validity in different clinical contexts and pathological scenarios.

Harnessing the host response for precision infectious disease diagnosis

SUMMARYDetection of the presence of infection and its etiology must be accurate and timely to facilitate appropriate antimicrobial use. Diagnostic strategies that rely solely on pathogen detection often are insufficient due to poor test characteristics, inability to differentiate colonization from infection, or protracted delay to result. Understanding the human response across different pathogens on a clinical and molecular level can provide more accurate, timely, and useful answers, especially in critical illness and diagnostic uncertainty. Improvements in understanding the human immune response including genomics, protein analysis, gene expression, and cellular morphology have led to rapid innovation of new host response-based diagnostic tests. This review describes the limitations of pathogen-focused technology and the benefits of examining the breadth of immune response to diagnose infection. It then explores biomarkers that have been studied for this purpose and scrutinizes the performance of host-based multianalyte testing. Currently cleared diagnostics and those in late-stage development are described in depth, with a focus on the purpose of testing and its utility for clinicians. Finally, it concludes by examining opportunities for further host response-derived diagnostic innovation.

Decoding Inflammation: Predicting Sepsis in the ICU

BACKGROUND

Sepsis is a life-threatening condition arising from a dysregulated host response to infection leading to organ dysfunction. Traditional clinical signs are often unreliable for detecting sepsis, necessitating the exploration of more accurate biomarkers. Furthermore, currently, recommended screening scores perform poorly, necessitating more effective biomarkers to identify sepsis. Therefore, in this study, we evaluated the predictive capabilities of six inflammatory biomarkers - C-reactive protein (CRP), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), monocyte distribution width (MDW), mean neutrophil volume (MNV), and mean monocyte volume (MMV) - measured from samples taken for complete blood count (CBC) for the development of sepsis in ICU patients.

METHODS

We conducted a prospective observational study involving ICU patients at a tertiary-care hospital in Hyderabad, India, over a one-year period to primarily assess the predictability of these six biomarkers for sepsis. As a secondary outcome, we also analyzed the predictiveness of the biomarkers with respect to mortality, the need for vasopressors, invasive mechanical ventilation or renal replacement therapy (RRT), the presence of organ failure, and hospital length of stay. Blood samples were collected for CRP and CBC on the first day of admission, from which RDW, NLR, MDW, MNV, and MMV were measured. Demographic data, including Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, clinical progression (recovery or mortality), requirement for vasopressors, invasive mechanical ventilation, RRT, presence of organ failure, and overall length of hospital stay, were documented.

RESULTS

We analyzed data from 84 patients after one patient withdrew consent. The study sample had a mean age of 65.83 years, with 60 (71.4%) patients >60 years of age and a male predominance (n = 50; 59.5%). About 57 (67.85%) patients had three or more comorbidities. About 71 (84.5%) patients met the sepsis-3 criteria. Mean APACHE II and SOFA scores were 18.73 and 5.36, respectively. Primary outcome analysis showed that CRP and MDW were the most sensitive, with sensitivities of 81.75% and 81.7%, respectively, whereas MDW, MNV, and MMV had the highest specificity at 100% each. Correlation analysis revealed that MDW had the best area under the curve (AUC) of 0.932 in predicting sepsis. Multivariate logistic regression identified both MDW and MMV to have a significant positive correlation in the prediction of sepsis. The overall mortality rate was 9.5%. About 82 (97.6%) patients had organ failure, 35 (41.7%) required vasopressors, 20 (23.8%) required invasive mechanical ventilation, 16 (19%) required RRT, and 59 (70.2%) had a hospital stay exceeding five days, with an average length of hospital stay of eight days. No biomarkers showed strong AUC or specificity compared to the SOFA score (0.710, 94.74% specificity in predicting mortality). However, among the six biomarkers, MDW was the most specific (86.84%). A CRP of >65 mg/L was the best indicator for prolonged hospital stay, vasopressor use, and RRT. An MMV of >179 and MDW of >21.86 U were the most sensitive markers for vasopressor requirements.

CONCLUSION

Our findings suggest that easily accessible biomarkers derived from routine CBC tests, particularly MDW and MMV, may serve as valuable tools for early sepsis diagnosis in resource-limited settings.

Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit

OBJECTIVES

Monocyte distribution width (MDW) is a measure of monocyte anisocytosis. In this study, we assessed the role of MDW, in comparison to C-reactive protein (CRP), procalcitonin (PCT), and lactate, as a screening and prognostic biomarker of sepsis in intensive care unit (ICU) by longitudinally measuring it in the first 5 days of hospital stay.

METHODS

We considered all consecutive patients admitted to the ICU. At admission, patients were classified as septic or not according to Sepsis-3 criteria. MDW, CRP, PCT, and lactate were measured daily in the first 5 days of hospitalization. ICU mortality was also recorded.

RESULTS

We included 193 patients, 62 with sepsis and 131 without sepsis (controls). 58% and 26 % of the patients, with and without sepsis respectively, died during ICU stay. MDW showed the highest accuracy for sepsis detection, superior to CRP, PCT, and lactate (AUC of 0.840, 0.755, 0.708, 0.622, respectively). At admission, no biomarker predicts ICU mortality in patients with sepsis. The kinetic of all biomarkers during the first 5 days of hospitalization was associated with ICU mortality. Noteworthy, above all, the kinetic of MDW showed the best accuracy. Specifically, an increase or decrease in MDW from day 1-4 and 5 was significantly associated with mortality or survival, respectively.

CONCLUSIONS

MDW is a reliable diagnostic and prognostic sepsis biomarker, better than traditional biomarkers.

The Role of Monocyte Distribution Width in the Early Prediction of Sepsis in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional Study

Background and Objectives: This is the first study to examine the role of monocyte distribution width (MDW) in predicting sepsis after cardiovascular surgery. Methods: This study included 43 consecutive patients who had undergone cardiovascular surgery between July 2021 and July 2022. All patients were examined at the following three time points (TPs): preoperative period (TP1), postoperative at 24 h (TP2), and discharge (TP3). SOFA score, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), MDW, C-reactive protein (CRP), and procalcitonin (PCT) levels were tested at each TPs. The Sepsis-3 criteria were used to diagnose patients with sepsis. Results: The mean values of all variables (leukocyte count, NLR, MDW, CRP, and PCT levels) were significantly higher at TP2 and TP3 than at TP1 (p < 0.05). All these values were significantly higher at TP2 than at TP3 (p < 0.05). Patients with sepsis had significantly higher mean values for leukocyte count, NLR, MDW, CRP, and PCT levels than those without sepsis (p < 0.05). There was a significant correlation between MDW and inflammatory markers (CRP, PCT, and NLR) during the three time periods (p < 0.05). According to the ROC analysis, the optimal MDW cutoff value with the highest sensitivity and specificity for predicting sepsis in the postoperative period was 20.5. Conclusions: Our findings indicate that elevated MDW levels may be a valuable predictor of sepsis in patients following cardiovascular surgery.

Monocyte distribution width (MDW) and DECAF: two simple tools to determine the prognosis of severe COPD exacerbation

Monocyte distribution width (MDW) has been associated with inflammation and poor prognosis in various acute diseases. Chronic obstructive pulmonary disease (COPD) exacerbations (ECOPD) are associated with mortality. The objective of this study was to evaluate the utility of the MDW as a predictor of ECOPD prognosis. This retrospective study included patient admissions for ECOPD. Demographic, clinical and biochemical information; intensive care unit (ICU) admissions; and mortality during admission were recorded. A total of 474 admissions were included. MDW was positively correlated with the DECAF score (r = 0.184, p < 0.001) and C-reactive protein (mg/dL) (r = 0.571, p < 0.001), and positively associated with C-RP (OR 1.115 95% CI 1.076-1.155, p < 0.001), death (OR 9.831 95% CI 2.981- 32.417, p < 0.001) and ICU admission (OR 11.204 95% CI 3.173-39.562, p < 0.001). High MDW values were independent risk factors for mortality (HR 3.647, CI 95% 1.313-10.136, p = 0.013), ICU admission (HR 2.550, CI 95% 1.131-5.753, p = 0.024), or either mortality or ICU admission (HR 3.084, CI 95% 1.624-5.858, p = 0.001). In ROC analysis, a combined MDW-DECAF score had better diagnostic power (AUC 0.777 95% IC 0.708-0.845, p < 0.001) than DECAF (p = 0.023), MDW (p = 0.026) or C-RP (p = 0.002) alone. MDW is associated with ECOPD severity and predicts mortality and ICU admission with a diagnostic accuracy similar to that of DECAF and C-RP. The MDW- DECAF score has better diagnostic accuracy than MDW or DECAF alone in identifying mortality or ICU admission.

Biomarkers in sepsis

Sepsis is a life-threatening condition characterized by dysregulated host response to infection leading to organ dysfunction. Despite advances in understanding its pathology, sepsis remains a global health concern and remains a major contributor to mortality. Timely identification is crucial for improving clinical outcomes, as delayed treatment significantly impacts survival. Accordingly, biomarkers play a pivotal role in diagnosis, risk stratification, and management. This review comprehensively discusses various biomarkers in sepsis and their potential application in antimicrobial stewardship and risk assessment. Biomarkers such as white blood cell count, neutrophil to lymphocyte ratio, erythrocyte sedimentation rate, C-reactive protein, interleukin-6, presepsin, and procalcitonin have been extensively studied for their diagnostic and prognostic value as well as in guiding antimicrobial therapy. Furthermore, this review explores the role of biomarkers in risk stratification, emphasizing the importance of identifying high-risk patients who may benefit from specific therapeutic interventions. Moreover, the review discusses the emerging field of transcriptional diagnostics and metagenomic sequencing. Advances in sequencing have enabled the identification of host response signatures and microbial genomes, offering insight into disease pathology and aiding species identification. In conclusion, this review provides a comprehensive overview of the current understanding and future directions of biomarker-based approaches in sepsis diagnosis, management, and personalized therapy.

Monocyte distribution width as a promising biomarker for differential diagnosis of chronic hepatitis, cirrhosis, and hepatocellular carcinoma

Objective

We aimed to investigate the association and diagnostic value of monocyte distribution width (MDW) for chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC).

Methods

MDW levels were measured in 483 individuals (103 CHB, 77 LC, 153 HCC, and 150 controls). MDW was detected using UniCel Dx900 for specific cell volume parameters and the distribution of cell volumes.

Results

Our findings revealed a dynamic upward change in MDW levels across different stages of chronic liver disease, from CHB to LC and HCC. In CHB, MDW levels were highest among HBeAg-positive CHB patients and exhibited a negative correlation with HBV markers while positively correlating with ALT levels. In LC, MDW showed a positive association with the pathological progression of LC, demonstrating consistency with CP scores. MDW proved to be equally effective as traditional detection for diagnosing LC. In HCC, MDW was positively correlated with HCC occurrence and development, with higher levels observed in the high MDW group, which also exhibited elevated AFP levels, MELD scores, and 90-day mortality rates. MDW surpassed predictive models in its effectiveness for diagnosing HCC, as well as CHB and LC, with respective areas under the curve of 0.882, 0.978, and 0.973. Furthermore, MDW emerged as an independent predictor of HCC.

Conclusion

MDW holds significant diagnostic efficacy in identifying CHB, LC, and HCC. These findings suggest that MDW could serve as a promising biomarker for predicting the severity of liver diseases and aid in rational clinical treatment strategies.

Circulating myeloid populations have prognostic utility in alcohol-related liver disease

Introduction

Alcohol-related liver disease (ARLD) accounts for over one third of all deaths from liver conditions, and mortality from alcohol-related liver disease has increased nearly five-fold over the last 30 years. Severe alcohol-related hepatitis almost always occurs in patients with a background of chronic liver disease with extensive fibrosis or cirrhosis, can precipitate 'acute on chronic' liver failure and has a high short-term mortality. Patients with alcohol-related liver disease have impaired immune responses, and increased susceptibility to infections, thus prompt diagnosis of infection and careful patient management is required. The identification of early and non-invasive diagnostic and prognostic biomarkers in ARLD remains an unresolved challenge. Easily calculated predictors of infection and mortality are required for use in patients who often exhibit variable symptoms and disease severity and may not always present in a specialized gastroenterology unit.

Methods

We have used a simple haematological analyser to rapidly measure circulating myeloid cell parameters across the ARLD spectrum.

Results and Discussion

We demonstrate for the first time that immature granulocyte (IG) counts correlate with markers of disease severity, and our data suggests that elevated counts are associated with increased short-term mortality and risk of infection. Other myeloid populations such as eosinophils and basophils also show promise. Thus IG count has the potential to serve alongside established markers such as neutrophil: lymphocyte ratio as a simply calculated predictor of mortality and risk of infectious complications in patients with alcohol-related hepatitis. This would allow identification of patients who may require more intensive management.

The Role of New Morphological Parameters Provided by the BC 6800 Plus Analyzer in the Early Diagnosis of Sepsis

BACKGROUND

Late diagnosis of sepsis is associated with adverse consequences and high mortality rate. The aim of this study was to evaluate the diagnostic value of hematologic research parameters, that reflect the cell morphology of blood cells, available on the BC 6800 plus automated analyzer (Mindray) for the early detection of sepsis.

MATERIALS AND METHODS

A complete blood count (CBC) was performed by Mindray BC 6800 Plus Analyzer in 327 patients (223 with a confirmed diagnosis of sepsis following sepsis-3 criteria, 104 without sepsis), admitted at the Intensive Care Unit of the Novara's Hospital (Italy) and in 56 patients with localized infection.

RESULTS

In univariate logistic regression, age, Hb, RDW, MO#, NMR, NeuX, NeuY, NeuZ, LymX, MonX, MonY, MonZ were associated with sepsis (p < 0.005). In multivariate analysis, only RDW, NeuX, NeuY, NeuZ, MonX and MonZ were found to be independent predictors of sepsis (p < 0.005). Morphological research parameters are confirmed to be predictors of sepsis even when analyzing the group with localized infection.

CONCLUSIONS

In addition to already established biomarkers and basic CBC parameters, new morphological cell parameters can be a valuable aid in the early diagnosis of sepsis at no additional cost.

Clinical implications of endotoxin activity and Polymyxin-B hemoperfusion in critically ill patients with septic cardiomyopathy: A single-center, retrospective, observational study

BACKGROUND

To explore the association between endotoxin activity (EA) and septic cardiomyopathy (SCM), the relationship between endotoxin removal by Polymyxin-B hemoperfusion (PMX-HP) and recovery from SCM (R-SCM), and the correlation between R-SCM and the 28-day mortality in septic patients admitted to the intensive care unit (ICU).

METHODS

Observational study that included patients admitted to two ICUs of a tertiary university hospital between April 2011 and December 2019, who received PMX-HP for sepsis/septic shock. The SCM and R-SCM were assessed by transthoracic echocardiography.

RESULTS

Among 148 patients, SCM was diagnosed in 60 (46%) of them and had no relationship with median EA (SCM group: 0.73; no-SCM group: 0.66, p = 0.48). Recovery from SCM was observed in 24 patients (49%) and was independently associated with the PMX-HP (OR 4.19, 95%CI [1.22, 14.3]; p = 0.02) and the SAPS2 II score (OR 0.94, 95%CI [0.9, 0.98]; p = 0.006). In the SCM group, the 28-day mortality was 60% and was independently predicted by R-SCM (OR 0.02, 95%CI [0.001, 0.3] p = 0.005) and SAPS II score (OR 1.11, 95%CI [1.01, 1.23] p = 0.037).

CONCLUSIONS

In septic patients, EA was not associated with SCM. However, endotoxin removal by Polymyxin-B hemoperfusion was associated with recovery from cardiomyopathy, which was a predictor of lower 28-day mortality.

Restoring the infected powerhouse: Mitochondrial quality control in sepsis

Sepsis is a dysregulated host response to an infection, characterized by organ failure. The pathophysiology is complex and incompletely understood, but mitochondria appear to play a key role in the cascade of events that culminate in multiple organ failure and potentially death. In shaping immune responses, mitochondria fulfil dual roles: they not only supply energy and metabolic intermediates crucial for immune cell activation and function but also influence inflammatory and cell death pathways. Importantly, mitochondrial dysfunction has a dual impact, compromising both immune system efficiency and the metabolic stability of end organs. Dysfunctional mitochondria contribute to the development of a hyperinflammatory state and loss of cellular homeostasis, resulting in poor clinical outcomes. Already in early sepsis, signs of mitochondrial dysfunction are apparent and consequently, strategies to optimize mitochondrial function in sepsis should not only prevent the occurrence of mitochondrial dysfunction, but also cover the repair of the sustained mitochondrial damage. Here, we discuss mitochondrial quality control (mtQC) in the pathogenesis of sepsis and exemplify how mtQC could serve as therapeutic target to overcome mitochondrial dysfunction. Hence, replacing or repairing dysfunctional mitochondria may contribute to the recovery of organ function in sepsis. Mitochondrial biogenesis is a process that results in the formation of new mitochondria and is critical for maintaining a pool of healthy mitochondria. However, exacerbated biogenesis during early sepsis can result in accumulation of structurally aberrant mitochondria that fail to restore bioenergetics, produce excess reactive oxygen species (ROS) and exacerbate the disease course. Conversely, enhancing mitophagy can protect against organ damage by limiting the release of mitochondrial-derived damage-associated molecules (DAMPs). Furthermore, promoting mitophagy may facilitate the growth of healthy mitochondria by blocking the replication of damaged mitochondria and allow for post sepsis organ recovery through enabling mitophagy-coupled biogenesis. The remaining healthy mitochondria may provide an undamaged scaffold to reproduce functional mitochondria. However, the kinetics of mtQC in sepsis, specifically mitophagy, and the optimal timing for intervention remain poorly understood. This review emphasizes the importance of integrating mitophagy induction with mtQC mechanisms to prevent undesired effects associated with solely the induction of mitochondrial biogenesis.

Comparison of the Diagnostic Accuracies of Monocyte Distribution Width, Procalcitonin, and C-Reactive Protein for Sepsis: A Systematic Review and Meta-Analysis

OBJECTIVES

We performed a systemic review and meta-analysis to evaluate the diagnostic accuracy of monocyte distribution width (MDW) and to compare with procalcitonin and C-reactive protein (CRP), in adult patients with sepsis.

DATA SOURCES

A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify all relevant diagnostic accuracy studies published before October 1, 2022.

STUDY SELECTION

Original articles reporting the diagnostic accuracy of MDW for sepsis detection with the Sepsis-2 or Sepsis-3 criteria were included.

DATA EXTRACTION

Study data were abstracted by two independent reviewers using a standardized data extraction form.

DATA SYNTHESIS

Eighteen studies were included in the meta-analysis. The pooled sensitivity and specificity of MDW were 84% (95% CI [79-88%]) and 68% (95% CI [60-75%]). The estimated diagnostic odds ratio and the area under the summary receiver operating characteristic curve (SROC) were 11.11 (95% CI [7.36-16.77]) and 0.85 (95% CI [0.81-0.89]). Significant heterogeneity was observed among the included studies. Eight studies compared the diagnostic accuracies of MDW and procalcitonin, and five studies compared the diagnostic accuracies of MDW and CRP. For MDW versus procalcitonin, the area under the SROC was similar (0.88, CI = 0.84-0.93 vs 0.82, CI = 0.76-0.88). For MDW versus CRP, the area under the SROC was similar (0.88, CI = 0.83-0.93 vs 0.86, CI = 0.78-0.95).

CONCLUSIONS

The results of the meta-analysis indicate that MDW is a reliable diagnostic biomarker for sepsis as procalcitonin and CRP. Further studies investigating the combination of MDW and other biomarkers are advisable to increase the accuracy in sepsis detection.

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.