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.
Interesting analysis of new information about monocyte distribution width as a marker for early sepsis. This compares with CRP and pro calcitonin for diagnostic accuracy. More work to be done, which is discussed in the article. Overall, this appears a promising measurement of early sepsis and similar sensitivity and specificity to CRP and pro calcitonin.
As an Internist, I found this information useful for my everyday clinical practice.
Forest plots of the sensitivity and specificity for monocyte distribution width showed substantial heterogeneity across all included studies, which is unacceptable to an inference conclusion.
This is a clear and precise paper. The conclusion suggests MDW is comparable to procalcitonin and CRP; however, further evaluation through an RCT and in specific disease populations is required.
Interesting novel lab technique. It seems sensitive but not very specific as an early sepsis tool. Further results to be awaited.