Host Response Biomarker of Sepsis Risk

Diagnostic uncertainty is a major challenge for patients presenting to emergency department (ED) with low number of signs and symptoms. What if an enhanced CBC was a way to help in early identification of risk of infection and sepsis?

Hematological Biomarker in the Emergency Department

Monocyte Distribution Width (MDW) is a measure of increased morphological variability of monocytes in response to bacterial, viral or fungal infections. The quantitative analysis of MDW has received regulatory-clearance as an aid in identifying risk of severe infection and sepsis in adult patients in the ED.

Considered with other signs and symptoms, the value of MDW helps differentiate sepsis from non-septic presentations, including non-infectious systemic inflammatory response.4 This parameter is available early in patient assessment as part of a complete blood count with differential test (CBC-diff), with no impact to workflow.


What Makes Monocyte Distribution Width Unique?


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

Reduce Dx Uncertainty

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

Enhanced CBC-Diff

MDW is available early in patient assessment as a part of a CBC-diff, ­no impact to workflow.

The value of MDW is that it provides physicians with an earlier indication of sepsis during the initial encounter, which is especially important when a patient’s symptoms are mild and alternative diagnosis are being considered.
Elliott Crouser, M.D., professor of Critical Care Medicine
Ohio State University Wexner Medical Center

Latest News

ArticleBecker Health

Dr. Phillip Levy, Professor of Emergency Medicine at Wayne State University, published Hiding in Plain Sight: The Case for MDW Parameter in Early Sepsis Screening in Becker Health. Dr. Levy reviews sepsis screening technology and latest tools that can impact hospital metrics.


In the latest installment of “Conversations with Industry,” from the American College of Emergency Physicians, MDW is the topic of focus for sepsis identification in the ED. Dr. Nima Sarani, from the University of Kansas Medical Center, discusses the latest evidence and practical utility of MDW.


New Society for Academic Emergency Medicine podcast series, “Current and Novel Approaches to Sepsis Detection in the ED.” SAEM Research and EMTIDE Interest Group members and academic emergency medicine providers discuss best practices for early sepsis identification and improved patient outcomes and the research surrounding biomarkers in an acute clinical setting.

MDW Patient Case Studies

Dr. Nima Sarani from Kansas University Medical Center shares the latest evidence and practical utility of the MDW aiding clinicians in escalating or de-escalating care­ in patients with suspected infectious etiology.

Latest Scientific Presentations

Watch this on-demand webinar in partnership with Sepsis Alliance, featuring Critical Care Clinical Nurse Specialist Kathleen Vollman, to take a deeper dive into the CBC test results with a special focus on the WBC differential. Uncover hidden gems and learn about clues pointing to sepsis recognition in order to provide the right care to the right patient at the right time. Watch recording ›

At ECCMID 2023, key experts discussed current practices and innovations needed to improve antibiotic use. Learn about current practices in the microbiology lab and the impact of new technology on improving antibiotic stewardship and patient outcomes. Watch recording ›

Peer-Reviewed Studies

MDW has been studied for the past decade with more than 16 peer-review publications and over 21,000+ patients6-16, confirming the robustness and reproducibility of MDW performance in different patient populations. View these peer-reviewed studies to learn about the clinical utility of MDW.

Critical Care Medicine Sepsis Study

Peer-Reviewed Clinical Study Critical Care Medicine Study

Discover how a multicenter study validated MDW as a novel indicator for Sepsis-2 and Sepsis-3 in high-risk emergency department patients.

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PLOS One Research Article MDW compared with CRP and PCT for Early Sepsis Detection in ED

Peer-Reviewed Clinical Study PLOS ONE Study

Research shows MDW compared with C-reactive protein and procalcitonin (PCT) for early sepsis detection in the ED.

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Journal of Intensive Care Article MDW enhances early sepsis detection in ED

Peer-Reviewed Clinical Study Journal of Intensive Care

New analysis from a pivotal study shows that patients with abnormal MDW values at presentation have increased odds of sepsis.

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Chest Journal Controlled Clinical Trial Improve Early Detection of Sepsis in the ED with MDW

Peer-Reviewed Clinical Study American College of Chest Physicians Study

Clinical research shows that MDW adds value to WBC count for early sepsis detection in the ED.

Read study

Additional Resources

1. Rudd, et al., Lancet. 2020 Jan 18; 395 (10219): 200-211.

2. Torio C, Moore B. “National Inpatient Hospital Costs: The Most Expensive Conditions by Payer.”, May 2016. Accessed 15 Jan. 2018.

3. Filbin, M. R., Lynch, J., Gillingham, T. D., Thorsen, J. E., Pasakarnis, C. L., Nepal, S., et al. Presenting Symptoms Independently Predict Mortality in Septic Shock. Critical Care Medicine, 2018; 46(10), 1592-1599.

4. UniCel DxH 900 Coulter Cellular Analysis System Early Sepsis Indicator (ESId) Application AddendumPN C42014AA.

5. Sepsis Pivotal Repository PN C54726 Rev. AB located in CPDM.

6. Malinovska, A et al., Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department. JACEP Open. 2022; 3:e12679.

7. E. Piva et al., Monocyte Distribution Width (MDW) Parameter as a Sepsis Indicator in Intensive Care Units, Clin Chem Lab Med 2021.

8. 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.

9. 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.

10. 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.

11. 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

12. G. Riva et al., Monocyte Distribution Width (MDW) as Novel Inflammatory Marker with Prognostic Significance in COVID 19 Patients, Scientific Report 2021; 11:12716.

13. 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.

14. 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.

15. 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.

16. 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.