Hematology Unit Medical Technology Laboratory, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Pathumthani, Thailand.
Am J Trop Med Hyg. 2023 Aug 28;109(4):926-932. doi: 10.4269/ajtmh.23-0104. Print 2023 Oct 4.
Early detection of dengue virus infection will lead to proper management and reduction in morbidity/mortality. Monocyte distribution width (MDW) was recently approved for use in the early detection of sepsis. Because monocytes are involved in the innate immune system against viral infection, we sought to determine changes in MDW to develop and validate a new predictive score for dengue viral infection. This study included patients who presented with symptoms or signs related to dengue infection and who had a complete blood count and dengue investigation performed during September 2019 to May 2020. The proportion of dengue infection was 29.5% in the current study. The MDW was significantly higher in dengue infection (median, 29.7 versus 24.2; P < 0.001). We then randomly separated patients into training and validation cohorts. Independent predictive factors of dengue infection were white blood cells < 4 × 109/L (score 1), platelets < 100 × 109/L (score 1), and MDW > 24 (score 1). Clinical features were not significantly predictive of dengue infection. The areas under the receiver operating characteristic curve (95% CI) of the prognostic score were 0.839 (0.779-0.899) in the training cohort and 0.742 (0.674-0.811) in the validation cohort. With a cutoff score ≥ 1, the sensitivity and specificity of the scores were 92.2% and 40.8% in the training cohort and 88.9% and 44.1% in the validation cohort, respectively. We concluded that MDW increases with dengue infection and MDW could easily be incorporated in the predictive scores for dengue infection.
早期发现登革热病毒感染可进行适当的管理，降低发病率/死亡率。单核细胞分布宽度（MDW）最近被批准用于早期检测败血症。由于单核细胞参与针对病毒感染的固有免疫系统，我们试图确定 MDW 的变化，以开发和验证一种新的登革热病毒感染预测评分。本研究纳入了 2019 年 9 月至 2020 年 5 月期间出现与登革热感染相关症状或体征且进行了全血细胞计数和登革热检查的患者。本研究中登革热感染的比例为 29.5%。登革热感染患者的 MDW 明显较高（中位数分别为 29.7 与 24.2；P < 0.001）。随后我们将患者随机分为训练和验证队列。登革热感染的独立预测因素为白细胞计数<4×109/L（评分 1）、血小板计数<100×109/L（评分 1）和 MDW>24（评分 1）。临床特征对登革热感染的预测作用不显著。预测评分的受试者工作特征曲线（95%CI）在训练队列中的曲线下面积为 0.839（0.779-0.899），在验证队列中的曲线下面积为 0.742（0.674-0.811）。当截断评分≥1 时，评分在训练队列中的敏感性和特异性分别为 92.2%和 40.8%，在验证队列中的敏感性和特异性分别为 88.9%和 44.1%。综上，MDW 随着登革热感染而增加，MDW 易于纳入登革热感染的预测评分中。
