Early Sepsis Identification in Cancer Patients


Early identification of sepsis in cancer patients is challenging as it can be complicated by the presence of inflammation from underlying disease and disease treatments, as well as ongoing antibiotic use.1 The risk of developing sepsis is 10-fold higher in cancer patients than in the general population,2 with up to 20% of sepsis patients having some form of cancer.2,3 And in patients with both cancer and sepsis diagnoses, hospital costs and length of stay are 3-fold higher3 and the risk of mortality is 2-3 fold higher than the general population.2,3

Rapid recognition and treatment of sepsis are essential for reducing time to theraputic intervetions and increasing survival. The complete blood count with differential (CBC-Diff), one of the first-line tests ordered in the Emergency Department (ED), provides a window into a patient’s overall health status. Harnessing the power specific CBC-Diff parameters for sepsis screening may aid in guiding clinicians to identify patients at high risk for sepsis.4 Further, using the CBC-Diff is desirable because of its timing and because it is both inexpensive and straightforward.1

Monocytes, part of both the innate and acquired immune systems, are the first line of defense against microbial infection.4 While the value of monocyte count (MO#) in sepsis identification has been limited,4 changes in the Monocyte Distribution Width (MDW) have proven valuable as an indication of pending immune dysregulation and subsequent sepsis.5–8

Unlike Procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL6), which are usually only ordered for patients in whom sepsis is suspected, MDW is available as part of the routine CBC-Diff. In this study, scientists from Serviço de Patologia Clínica do Instituto Português de Oncologia de Coimbra in Portugal investigated the prognostic value of MDW compared with other sepsis biomarkers, PCT, CRP, and IL6, along with Complete Blood Count parameters, LEU# (leucocyte number), and MO# for identifying sepsis in 157 cancer patients in the ED.

The study found:

  • Only MDW showed adequate logistic regression as an independent predictor of sepsis (p<0.001) and presented the highest AUC for sepsis (0.735) followed by PCT (0.718)
  • An MDW value of 26.435 provided a negative predictive value of 93.5%
  • Introduction of MDW as a sepsis screening test, together with other sepsis biomarkers, has a tremendous opportunity to improve the sepsis screening accuracy in oncology patients with a routinely ordered CBD-diff test

At a Glance


Oncology patients with sepsis


AUC—showing robust performance for sepsis screening

93.5 %

NPV indicating decreased probability of sepsis


Read the full EuroMedLab 2023 Poster here
Learn more about MDW


1. Vincent J-L. The clinical challenge of sepsis identification and monitoring. PLoS Med. 2016;13(5):e1002022. doi:10.1371/journal.pmed.1002022

2. Sepsis Alliance. Sepsis and Cancer Fact Sheet. Sepsis and Cancer. March 2020. Accessed September 6, 2023. https://www.sepsis.org/?s=cancer

3. Williams MD, Braun LA, Cooper LM, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291-8. doi:10.1186/cc2893

4. Agnello L, Giglio RV, Bivona G, et al. The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis. Diagnostics (Basel). 2021;11(10). doi:10.3390/diagnostics11101881

5. Hausfater P, Robert Boter N, Morales Indiano C, 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(1):227. doi:10.1186/s13054-021-03622-5

6. Polilli E, Frattari A, Esposito JE, et al. Monocyte Distribution Width (MDW) as a New Tool for the Prediction of Sepsis in Critically Ill Patients: A Preliminary Investigation in an Intensive Care Unit. BMC Emerg Med. 2021;21(1):147. doi:10.1186/s12873-021-00521-4

7. Crouser ED, Parrillo JE, Seymour C, et al. Improved Early Detection of Sepsis in the ED with a Novel Monocyte Distribution Width Biomarker. Chest. 2017;152(3):518-526. doi:10.1016/j.chest.2017.05.039

8. Crouser ED, Parrillo JE, Seymour CW, et al. Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients. Crit Care Med. 2019;47(8):1018-1025. doi:10.1097/CCM.0000000000003799