• Alexandra Malinovska, Benjamin Hernried, Andrew Lin, Oluwakemi Badaki-Makun, Katherine Fenstermacher, Ann Margret Ervin, Stephan Ehrhardt, Scott Levin, and Jeremiah S Hinson.
• Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
• Chest. 2023 Jul 1; 164 (1): 101113101-113.

BackgroundMonocyte distribution width (MDW) is an emerging biomarker for infection. It is available easily and quickly as part of the CBC count, which is performed routinely on hospital admission. The increasing availability and promising results of MDW as a biomarker in sepsis has prompted an expansion of its use to other infectious diseases.Research QuestionWhat is the diagnostic performance of MDW across multiple infectious disease outcomes and care settings?Study Design And MethodsA systematic review of the diagnostic performance of MDW across multiple infectious disease outcomes was conducted by searching PubMed, Embase, Scopus, and Web of Science through February 4, 2022. Meta-analysis was performed for outcomes with three or more reports identified (sepsis and COVID-19). Diagnostic performance measures were calculated for individual studies with pooled estimates created by linear mixed-effects models.ResultsWe identified 29 studies meeting inclusion criteria. Most examined sepsis (19 studies) and COVID-19 (six studies). Pooled estimates of diagnostic performance for sepsis differed by reference standard (Second vs Third International Consensus Definitions for Sepsis and Septic Shock criteria) and tube anticoagulant used and ranged from an area under the receiver operating characteristic curve (AUC) of 0.74 to 0.94, with mean sensitivity of 0.69 to 0.79 and mean specificity of 0.57 to 0.86. For COVID-19, the pooled AUC of MDW was 0.76, mean sensitivity was 0.79, and mean specificity was 0.59.InterpretationMDW exhibited good diagnostic performance for sepsis and COVID-19. Diagnostic thresholds for sepsis should be chosen with consideration of reference standard and tube type used.Trial RegistryProspero; No.: CRD42020210074; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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