Severity of Infection Marker

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 severity of infection and risk of sepsis?

Hematological Biomarker in the Emergency Department

Monocyte Distribution Width

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 severity of infection and risk of 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) on the DxH 900 and DxH 690T hematology analyzers*, with no impact to workflow.

 

What Makes Monocyte Distribution Width Unique?

FDA-Cleared

MDW, proprietary to Beckman Coulter analyzers, is the only FDA-cleared hematological biomarker that helps to establish severity of infection and risk of sepsis in adult patients in the ED.

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

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.

  • 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
  • Avoiding Unnecessary Administration of Antibiotics
    Avoiding Unnecessary Administration of Antibiotics

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

    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
  • Decreased Probability of Sepsis Diagnosis
    Identifying a Decreased Probability of Sepsis Diagnosis

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

    View case study

Latest Scientific Presentations

Watch ISICEM symposium recording to hear Profs. Jean-Louis Vincent, Pierre Hausfater and Fernando Arméstar Rodríguez discussion on MDW and the latest clinical evidence for its utility to detect severe infection and risk of sepsis. View on demand ›

Watch the ACEP22 recording where Drs. Levy and Sarani review the latest clinical evidence for MDW derived from the series of multicenter studies, discuss implications of these results for U.S. standards of patient care and present practical aspects of MDW utility in clinical practice. Watch recording ›

Watch this sponsored recording in partnership with Sepsis Alliance featuring Kathleen Vollman, MSN, RN, CCNS, FCCM, FCNS, FAAN to learn about early sepsis recognition strategies that can help differentiate the severity of infection and risk of sepsis in the ED.Watch recording ›

Watch the ISLH on-demand workshop to hear Dr. Czader, Indiana University, and Dr. Morales, University Hospital Germans Trias i Pujol, discuss the role of monocytes and neutrophils in innate immune response to infection, monocytes morphology in clinical decision-making and present emerging evidence based on multicentric European clinical trials. 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



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* Using Early Sepsis Indicator application on Beckman Coulter DxH 900 and 690T hematology analyzer. Activation required.  

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.” www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf, 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. https://doi.org/10.1097/ccm.0000000000003260.

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. https://doi.org/10.1002/emp2.12679

7. 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

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. https://doi.org/10.1186/s13054-021-03622-5

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. https://doi.org/10.1371/journal.pone.0250101

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. https://doi.org/10.1371/journal.pone.0241262

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. https://doi.org/10.1038/s41598-021-92236-6

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. https://doi.org/10.1016/j.injury.2021.11.026

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. https://doi.org/10.1097/CCM.0000000000003799

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. https://doi.org/10.1016/j.chest.2017.05.039

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. https://doi.org/10.1016/j.cca.2020.06.002