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Licensed Unlicensed Requires Authentication Published by De Gruyter June 29, 2020

Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department

  • Luisa Agnello , Giulia Bivona , Matteo Vidali , Concetta Scazzone , Rosaria Vincenza Giglio , Giorgia Iacolino , Alessandro Iacona , Silvia Mancuso , Anna Maria Ciaccio , Bruna Lo Sasso and Marcello Ciaccio EMAIL logo



The diagnosis of sepsis in the Emergency Department (ED) is challenging and a reliable biomarker is needed. The current study aimed to evaluate the diagnostic accuracy of monocyte distribution width (MDW) for the early identification of sepsis in the ED.


We performed a large observational study including consecutive adult patients (≥18 years of age) presenting to the ED between September and November 2019, with an order for complete blood count (CBC) evaluation. A total of 2,215 patients were enrolled and classified based on Sepsis-2 criteria as the control group (1,855), infection group (172), Systemic Inflammatory Response Syndrome (SIRS) group (100), and sepsis group (88).


MDW levels were higher in patients with sepsis than in all other groups (p<0.001). ROC curve analysis showed an optimal diagnostic accuracy of MDW for sepsis prediction at a cut-off point of 23.5, with an AUC of 0.964, sensitivity and specificity of 0.920 and 0.929, respectively.


Our findings encourage further investigation to validate the use of MDW as a screening tool for the early identification of patients at risk of sepsis in the ED.

Corresponding author: Professor Marcello Ciaccio, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro, 129, CAP 90127, Palermo, Sicily, Italy; Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy, Phone: 0039 09123865707, E-mail:


Beckman Coulter provided the reagents for MDW measurement.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: The study protocol was approved by the Ethics Committee of the University Hospital of Palermo (nr 07/2019) and was performed in accordance with the current revision of the Helsinki Declaration.


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Supplementary Material

The online version of this article offers supplementary material

Received: 2020-04-01
Accepted: 2020-05-19
Published Online: 2020-06-29
Published in Print: 2020-10-25

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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