Value of Monocyte Distribution Width in Bacteremia Assessment in Emergency Department Patients
Recommended Citation
Jaehne AK, Naiman M, Cook B, Wilson I, Veryser D, Kelly W, Ghosh S, Rivers EP. Value of Monocyte Distribution Width in Bacteremia Assessment in Emergency Department Patients. Am J Respir Crit Care Med 2024; 209.
Document Type
Conference Proceeding
Publication Date
5-21-2024
Publication Title
Am J Respir Crit Care Med
Abstract
Rationale Monocyte distribution width (MDW) is a pathogen-agnostic marker of immune response and dysregulation reported as part of a Complete Blood Count (CBC) with differential. MDW is derived from the distribution of peripheral blood monocyte volumes and aids in the identification of severe infections and sepsis in adult Emergency Department (ED) patients. Several prospective clinical trials have demonstrated that elevated MDW values are associated with severe infection in the general adult ED population. Additional real-world examination can help refine interpretation in early clinical scenarios. MDW could play a useful role in assessing bacteremia and septicemia risk. Bacteremia, defined as the presence of viable bacteria in the bloodstream, is present in up to 20% of sepsis patients. Blood culture establishes pathogen presence and identity but requires time. This may limit a more aggressive treatment strategy. The purpose of this study was to characterize MDW clinical behavior in the context of bacteremia upon hospital presentation. Methods This was a prospective, observational cohort study. All patients who presented to the ED, were over 18 years of age, and had a blood culture order along with a CBC with differential were enrolled into the study. MDW values were blinded to those involved in direct patient care. An MDW value ≥20 is the published cut-off for increased severe infection risk. We calculated the diagnostic accuracy of MDW values ≥20 for positive blood cultures using SPSS Version 25. Results From July 2021 to September 2023 a total of 185,405 ED visits were registered. During this time 9,400 ED blood cultures were ordered. A total of 5,316 ED blood culture results were matched with MDW results. The overall blood culture positivity rate was 14.5%. MDW sensitivity and specificity for positive blood culture were 83.9% and 36.2%, respectively. Positive and negative predictive values were 18.2% and 93.0%, respectively. Conclusion This interim analysis suggests that MDW may be a useful adjunct for early detection of bacteremia in ED patients. The observed sensitivity is consistent with the known relationship between positive blood culture and sepsis. Since MDW results can be available well before blood culture results, this biomarker could help early risk stratification among suspected infection patients. MDW values below 20 have a high predicative value for negative blood cultures. Further analysis incorporating additional clinical information will provide guidance for interpreting MDW values in combination blood culture results.
Volume
209
