Lin Sheng-Feng, Lin Hui-An, Hou Peter C, Tsai Hung-Wei, Hou Sen-Kuang
Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
PLoS One. 2025 Jun 3;20(6):e0325314. doi: 10.1371/journal.pone.0325314. eCollection 2025.
Monocyte distribution width (MDW) may serve as an infection marker in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), where infection rates range from 2.4% to 16.6%. We evaluated the association of increased MDW levels with infection occurrence and to assess MDW-based models for predicting infection risk and prolonged hospital length of stay (LOS) ≥ 7 days.
This retrospective cohort study included AMI patients undergoing PCI at a Taiwanese tertiary teaching hospital from January 1, 2020, to September 30, 2021. Logistic regression models incorporating MDW, Quick Sequential Organ Failure Assessment (qSOFA) score, age, and C-reactive protein (CRP) levels were compared to the Canada Acute Coronary Syndrome (C-ACS) score and stress hyperglycemia ratio (SHR). Among 252 patients, 12.7% developed infections, a rate that falls within the expected range. Infections were more frequent among patients with LOS ≥ 7 days (42.9% vs. 1.1%). A three-parameter model (qSOFA score ≥2, age ≥ 65, and MDW ≥ 20) demonstrated good performance for new infection (AUC: 0.834) and LOS ≥ 7 days (AUC: 0.714). Adding CRP ≥ 2 mg/dL improved predictions for infection (AUC: 0.909) and LOS ≥ 7 days (AUC: 0.798), outperforming the C-ACS score (AUC: 0.807) and SHR (AUC: 0.784).
MDW emerges as a promising biomarker for assessing the risks of infection and prolonged hospital LOS in patients with AMI. Its early use may facilitate timely clinical interventions, including earlier initiation of antibiotic therapy.
单核细胞分布宽度（MDW）可能是接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者的感染标志物，此类患者的感染率在2.4%至16.6%之间。我们评估了MDW水平升高与感染发生之间的关联，并评估基于MDW的模型对感染风险和延长住院时间（LOS）≥7天的预测能力。
这项回顾性队列研究纳入了2020年1月1日至2021年9月30日在台湾一家三级教学医院接受PCI的AMI患者。将纳入MDW、快速序贯器官衰竭评估（qSOFA）评分、年龄和C反应蛋白（CRP）水平的逻辑回归模型与加拿大急性冠状动脉综合征（C-ACS）评分和应激性高血糖比率（SHR）进行比较。在252例患者中，12.7%发生了感染，该发生率在预期范围内。LOS≥7天的患者感染更为频繁（42.9%对1.1%）。一个三参数模型（qSOFA评分≥2、年龄≥65且MDW≥20）对新发感染（曲线下面积[AUC]：0.834）和LOS≥7天（AUC：0.714）显示出良好的预测性能。添加CRP≥2mg/dL可改善对感染（AUC：0.909）和LOS≥7天（AUC：0.798）的预测，优于C-ACS评分（AUC：0.807）和SHR（AUC：0.784）。
MDW成为评估AMI患者感染风险和延长住院LOS的一个有前景的生物标志物。其早期应用可能有助于及时进行临床干预，包括更早开始抗生素治疗。
