Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy.
Department of Medicine-DIMED, University of Padova, Padova, Italy.
Clin Chem Lab Med. 2021 Mar 5;59(7):1307-1314. doi: 10.1515/cclm-2021-0192. Print 2021 Jun 25.
Patients in Intensive Care Units (ICU) are a high-risk population for sepsis, recognized as a major cause of admission and death. The aim of the current study was to evaluate the diagnostic accuracy and prognostication of monocyte distribution width (MDW) in sepsis for patients admitted to ICU.
Between January and June 2020, we conducted a prospective observational study during the hospitalization of 506 adult patients admitted to the ICU. MDW was evaluated in 2,367 consecutive samples received for routine complete blood counts (CBC) performed once a day and every day during the study. Sepsis was diagnosed according to Sepsis-3 criteria and patients enrolled were classified in the following groups: no sepsis, sepsis and septic shock.
MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group [median 26.23 (IQR: 23.48-29.83); 28.97 (IQR: 21.27-37.21); 21.99 (IQR: 19.86-24.36) respectively]. ROC analysis demonstrated that AUC is 0.785 with a sensitivity of 66.88% and specificity of 77.79% at a cut-off point of 24.63. In patients that developed an ICU-acquired sepsis MDW showed an increase from 21.33 [median (IQR: 19.47-21.72)] to 29.19 [median (IQR: 27.46-31.47)]. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19. In sepsis survivors a decrease of MDW values were found from the first time to the end of their stay [median from 29.14 (IQR: 26.22-32.52) to 25.67 (IQR: 22.93-30.28)].
In ICU, MDW enhances the sepsis detection and is related to disease severity.
重症监护病房（ICU）的患者是脓毒症的高危人群，脓毒症是导致入住 ICU 和死亡的主要原因。本研究旨在评估单核细胞分布宽度（MDW）在 ICU 入住患者脓毒症中的诊断准确性和预后价值。
在 2020 年 1 月至 6 月期间，我们进行了一项前瞻性观察性研究，纳入了 506 名入住 ICU 的成年患者。每天一次对常规全血细胞计数（CBC）进行 2367 次连续样本评估。根据 Sepsis-3 标准诊断脓毒症，将纳入的患者分为以下几组：无脓毒症、脓毒症和脓毒性休克。
与无脓毒症组相比，脓毒症或脓毒性休克患者的 MDW 值显著升高[中位数 26.23（IQR：23.48-29.83）；28.97（IQR：21.27-37.21）；21.99（IQR：19.86-24.36）]。ROC 分析显示，截断值为 24.63 时，AUC 为 0.785，灵敏度为 66.88%，特异性为 77.79%。在发生 ICU 获得性脓毒症的患者中，MDW 从 21.33[中位数（IQR：19.47-21.72）]增加至 29.19[中位数（IQR：27.46-31.47）]。MDW 的增加不受脓毒症病因的影响，即使在 COVID-19 患者中也是如此。在脓毒症存活者中，从第一次到住院结束，MDW 值下降[中位数从 29.14（IQR：26.22-32.52）降至 25.67（IQR：22.93-30.28）]。
在 ICU 中，MDW 提高了脓毒症的检出率，并与疾病严重程度相关。
