Monocyte Distribution Width Performance in Emergency Department Patients that Undergo Surgery
Recommended Citation
Cook B, Naiman M, Montomery Z, Chalhoub S, Gill J, Wilson I, Veryser D, Ghosh S, Obeid N, Shah R, Rivers E, Jaehne AK. Monocyte Distribution Width Performance in Emergency Department Patients that Undergo Surgery. Clin Chem 2025; 71:i111.
Document Type
Conference Proceeding
Publication Date
10-2-2025
Publication Title
Clin Chem
Abstract
BACKGROUND: Patients that present to the Emergency Department (ED) with conditions that require surgical intervention are often more difficult to assess for systemic infection or sepsis. Signs and symptoms consistent with surgical disease, such as fever, elevated inflammatory markers, tachycardia, and pain, may confound standard sepsis screening and mask a blood stream infection (BSI). In these cases, a high degree of clinical suspicion is required to start broad spectrum antimicrobial therapy. The current gold standard for BSI diagnosis is blood cultures. Blood culture results can also guide specific antimicrobial treatment. However, blood cultures may take hours to days for results. Given the importance of treating sepsis and bacteremia as soon as possible, additional blood markers of bacteremia and sepsis risk could be beneficial. Monocyte distribution width (MDW) is a pathogen agnostic marker that has been evaluated for the early identification of community acquired sepsis in Emergency Department (ED) patients. MDW is a measurement of the size distribution of peripheral blood monocytes and is reported as part of a complete blood count (CBC) with differential. MDW used as an adjunct could recognize BSI and sepsis risk in surgical patients before the blood culture results are available and may be useful to identify persistent BSI, despite surgical source control. METHODS: This was an observational cohort study of adult (>18 years) ED patients presenting to an urban tertiary teaching hospital from 07/ 2021-12/2023 (IRB 14940, NCT05296590). Patients were included if they had valid results from a CBC with differential, blood cultures collected in the ED and underwent surgery. All treating providers were blinded to MDW results. Diagnostic performance of MDW was evaluated against blood culture results. An MDW cutoff of greater than 20 is considered positive for increased sepsis risk. Statistical performance assessments were calculated in SPSS Version25. RESULTS: 1057 patients met the inclusion criteria. Positive blood cultures were reported in 231 (21.9%) patients admitted for surgery. The mean MDW value was significantly higher in BSI patients (27.1, SD 7.21 v. 23.0, SD 5.9). MDW demonstrated sensitivity of 89.2%, specificity of 31.6%, negative predictive value of 91.3% and positive predictive value of 26.7%. CONCLUSION: MDW is a useful marker of BSI and sepsis risk in patients presenting to the ED and may provide essential information for those patients admitted for surgical interventions. Positive blood culture results have not been adjusted to account for contamination, which could influence MDW performance estimates. Also, as a pathogen-agnostic marker, MDW elevation in blood-culture negative patients may result from infections of non-bacterial etiology. More research should address the optimal incorporation ofMDWin surgical workflows for infectious source control.
Volume
71
First Page
i111
