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Home / Clinical Laboratory Diagnostic Products and Solutions / Hematology / Monocyte Distribution Width

Monocyte Distribution Width

Host response biomarker of sepsis risk

Monocyte Distribution Width (MDW) is the only regulatory-cleared hematological biomarker that helps to establish risk of severe infection and sepsis in adult patients in the emergency department. MDW is a measure of increased morphological variability of monocytes in response to bacterial, viral or fungal infections.

MDW is reported automatically as part of a routine CBC with Differential test using the Early Sepsis Indicator (ESId) application*, which enables automatic reporting with no workflow changes or need to order an additional test.

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Regulatory-Cleared

MDW is the only regulatory-cleared hematological biomarker that helps to establish risk of severe infection and sepsis in adult patients in the ED.

Available Early

MDW helps reduce diagnostic uncertainty. It is available early to help clinicians escalate or de-escalate care in patients with suspected infectious etiology.

CBC Diff

MDW is available early in patient assessments as part of CBC with Differential tests—no need to order additional tests.

By including MDW in our thought process, we can potentially uncover an underlying sepsis that could have been otherwise missed, especially when other causes can explain a patient’s symptoms.
Nima Sarani, M.D.
University of Kansas Medical Center
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Diagnostic Uncertainty

Clinicians are faced with time pressures to make early risk stratification decisions for patient disposition and treatment initiation. Clinicians must triage patients and quickly determine where they need to go. In many cases, the patients may be discharged home or, perhaps, missed to taken ICU, but rather to the general ward – and both scenarios are associated with increased mortality - higher mortality in patients discharged to the general ward (42.7%) or home (61.6%) vs. ICU (29.5%).2-3 Initial disposition home of emergency department patients with potential sepsis results in twice the mortality and 4x healthcare costs per patient.1 

Diagnostic uncertainty is a major challenge for patients presenting to the emergency department with a low number of signs and symptoms. Over 30% of septic shock patients that present with vague symptoms may be missed by the EMR alerts, encounter longer time to antibiotics, and experience worse outcomes.4

Mitigate Diagnostic Uncertainty

MDW is available early in-patient assessment to help determine patient acuity and risk of sepsis.

npv-ppv-graph-for-the-web US-version

What Makes MDW Unique?

  • Monocyte Activation is a common physiological signal in severe infection and sepsis
  • MDW is backed by rigorously designed patient trials and several rounds of in-depth review to meet the standards required for regulatory-clearance and CE mark
  • MDW helps reduce diagnostic uncertainty. It is available early to enhance the initial risk assessment and potentially shift your clinical decision point helping clinicians escalate or de-escalate care

Toolbox

Navigating the uncertainties of sepsis and severe infection is challenging. In this short training video, Melissa Naiman, PhD, EMT-B shares the fundamentals of MDW and explains the clinical utility of incorporating the MDW biomarker as part of the CBC-diff early in ED screening to aid in identifying severity of infection and risk of sepsis.

MDW Patient Case Studies

MDW has been studied for the past decade with more than 60 peer-review publications and over 30,000+ patients.6-16, confirming the robustness and reproducibility of MDW performance in different patient populations. Learn more about MDW by reviewing the patient case studies below.
CBC Sepsis

CBC-based Sepsis Screening Tool with MDW

Learn how scientists derived the CBC Index to estimate the likelihood of ED patients to develop sepsis.

View case study
SAEM

Decrease Time to Abx for Patients with Occult Symptoms

Learn how clinicians are using MDW to decrease time to antibiotics for patients with occult symptoms.

View case study
Avoiding Unnecessary Administration of Antibiotics

Avoiding Unnecessary Administration of Antibiotics

See how the inclusion of MDW in patient assessment helped clinicians avoid unnecessary use of antibiotics.

View case study
Decreased Probability of Sepsis Diagnosis

Identifying a Decreased Probability of Sepsis Diagnosis

Inclusion of MDW in patient assessment helped clinicians understand the decreased probability of sepsis, which avoided administration of a broad-spectrum antibiotics and its adverse effects.

View case study
MDW-Spotlight-600x300

T-47 Minutes to Antibiotics Administration

MDW biomarker identified a risk of severe infection and reclassified the patient into higher acuity category in conjunction with current standard of care.

View case study
MDW-patient-case-study-600x300

Abnormal MDW 27.3 Changed Patient’s Trajectory

The inclusion of MDW in the clinical thought process helped physicians to uncover an underlying infection which could have otherwise been missed leading to inappropriate therapeutic interventions.

View case study

Sepsis Diagnosis: Saving 85 Minutes to Start Abx

Learn how elevated MDW along with clinical correlation prompted a sepsis diagnosis and helped eliminate 85 minutes of source control, allowing for prompt antibiotic administration.

View case study

Educational Resources

*Activation is required.

  1. S. Fernando et al., Emergency Department Disposition Decisions and Associated Mortality and Costs in ICU Patients with Suspected Infection, Crit Care 2018; 22,172. https://doi.org/10.1186/s13054-018-2096-8
  2. E. Rivers et al., Early and Innovative Interventions for Severe Sepsis and Septic Shock: Taking Advantage of a Window of Opportunity, CMAJ 2005; 173(9):1054-65. https://doi.org/10.1503/cmaj.050632 
  3. A. Vijayan et al., Procalcitonin: A Promising Diagnostic Marker for Sepsis and Antibiotic Therapy, Journal of Intensive Care 2017; 5:51. https://doi.org/10.1186/s40560-017-0246-8
  4. M. Filbin et al., Presenting Symptoms Independently Predict Mortality in Septic Shock: Importance of a Previously Unmeasured Confounder, Critical Care Medicine 2018; 46(10), 1592-1599. https://doi.org/10.1097/ccm.0000000000003260 
  5. UniCel DxH 900 Coulter Cellular Analysis System Early Sepsis Indicator (ESId) Application Addendum PN C42014AC April 2020
  6. E. Piva et al., Monocyte Distribution Width (MDW) Parameter as a Sepsis Indicator in Intensive Care Units, Clin Chem Lab Med 2021. https://doi.org/10.1515/cclm-2021-0192 
  7. P. Hausfater et al., Monocyte Distribution Width (MDW) Performance as an Early Sepsis Indicator in the Emergency Department: Comparison with CRP and Procalcitonin in a Multicenter International European Prospective Study, Crit Care 2021; 25, 227. https://doi.org/10.1186/s13054-021-03622-5 
  8. A. Woo et al., Monocyte Distribution Width Compared with C-Reactive Protein and Procalcitonin for Early Sepsis Detection in the Emergency Department, PLoS ONE 2021; 16(4): e0250101. https://doi.org/10.1371/journal.pone.0250101 
  9. H. Lin et al., Clinical Impact of Monocyte Distribution Width and Neutrophil-to-Lymphocyte Ratio for Distinguishing COVID-19 and Influenza from Other Upper Respiratory Tract Infections: A Pilot Study, PLoS ONE 2020 15(11): e0241262. https://doi.org/10.1371/journal.pone.0241262
  10. L. Agnello et al., Monocyte Distribution Width (MDW) as a Screening Tool for Sepsis in the Emergency Department, Clin Chem Lab Med 2020; 58(11):1951-1957. https://doi:10.1515/cclm-2020-0417
  11.  G. Riva et al., Monocyte Distribution Width (MDW) as Novel Inflammatory Marker with Prognostic Significance in COVID‑19 Patients, Scientific Report 2021; 11:12716. https://doi.org/10.1038/s41598-021-92236-6 
  12. Marcos-Morales, A et al., Elevated monocyte distribution width in trauma: An early cellular biomarker of organ dysfunction, Injury 2021; S0020-1383(21):00933-00935. https://doi.org/10.1016/j.injury.2021.11.026 
  13. E. Crouser et al., Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients, Critical Care Med 2019; 47:1018-1025. https://doi.org/10.1097/CCM.0000000000003799
  14. E. Crouser et al., Improved Early Detection of Sepsis in the ED with a Novel Monocyte Distribution Width Biomarker, CHEST 2017; 152(3):518-526. https://doi.org/10.1016/j.chest.2017.05.039
  15. A. Ognibene et al., Elevated Monocyte Distribution Width in COVID-19 Patients: The Contribution of the Novel Sepsis Indicator, Clinica Chimica Acta 2020; 509: 22-24. https://doi.org/10.1016/j.cca.2020.06.002
  16. Malinovska, A et al., Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department. JACEP Open. 2022; 3:e12679. https://doi.org/10.1002/emp2.12679
 
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