Monocyte distribution width compared with C-reactive protein and procalcitonin for early sepsis detection in the emergency department

PURPOSE: Monocyte distribution width (MDW) has been suggested as an early biomarker of sepsis, but few studies have compared MDW with conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT). This study evaluated MDW as a biomarker for sepsis and compared it with CRP and PCT. MATERIALS AND METHODS: Patients aged 18–80 years who visited the emergency department were screened and prospectively enrolled in a tertiary medical center. Complete blood count, MDW, CRP, and PCT were examined. Diagnostic performance for sepsis was tested using the area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity. RESULTS: In total, 665 patients were screened, and 549 patients with valid laboratory test results were included in the analysis. The patients were categorized into three groups according to the Sepsis-3 criteria: non-infection, infection, and sepsis. MDW showed the highest value in the sepsis group (median [interquartile range], 24.0 [20.8–27.8]). The AUC values for MDW, CRP, PCT, and white blood cells for predicting sepsis were 0.71 (95% confidence interval [CI], 0.67–0.75), 0.75 (95% CI, 0.71–0.78], 0.76 (95% CI, 0.72–0.79, and 0.61 (95% CI, 0.57–0.65), respectively. With the optimal cutoff value of the cohort, the sensitivity was 83.0% for MDW (cutoff, 19.8), 69.7% for CRP (cutoff, 4.0), and 76.6% for PCT (cutoff, 0.05). The combination of quick Sequential Organ Failure Assessment (qSOFA) with MDW improved the AUC (0.76; 95% CI, 0.72–0.80) to a greater extent than qSOFA alone (0.67; 95% CI, 0.62–0.72). CONCLUSIONS: MDW reflected a diagnostic performance comparable to that of conventional diagnostic markers, implying that MDW is an alternative biomarker. The combination of MDW and qSOFA improves the diagnostic performance for early sepsis.