Comparison of the Diagnostic Accuracies of Monocyte Distribution Width, Procalcitonin, and C-Reactive Protein for Sepsis: A Systematic Review and Meta-Analysis

Abstract

Objectives: We performed a systemic review and meta-analysis to evaluate the diagnostic accuracy of monocyte distribution width (MDW) and to compare with procalcitonin and C-reactive protein (CRP), in adult patients with sepsis.

Data sources: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify all relevant diagnostic accuracy studies published before October 1, 2022.

Study selection: Original articles reporting the diagnostic accuracy of MDW for sepsis detection with the Sepsis-2 or Sepsis-3 criteria were included.

Data extraction: Study data were abstracted by two independent reviewers using a standardized data extraction form.

Data synthesis: Eighteen studies were included in the meta-analysis. The pooled sensitivity and specificity of MDW were 84% (95% CI [79-88%]) and 68% (95% CI [60-75%]). The estimated diagnostic odds ratio and the area under the summary receiver operating characteristic curve (SROC) were 11.11 (95% CI [7.36-16.77]) and 0.85 (95% CI [0.81-0.89]). Significant heterogeneity was observed among the included studies. Eight studies compared the diagnostic accuracies of MDW and procalcitonin, and five studies compared the diagnostic accuracies of MDW and CRP. For MDW versus procalcitonin, the area under the SROC was similar (0.88, CI = 0.84-0.93 vs 0.82, CI = 0.76-0.88). For MDW versus CRP, the area under the SROC was similar (0.88, CI = 0.83-0.93 vs 0.86, CI = 0.78-0.95).

Conclusions: The results of the meta-analysis indicate that MDW is a reliable diagnostic biomarker for sepsis as procalcitonin and CRP. Further studies investigating the combination of MDW and other biomarkers are advisable to increase the accuracy in sepsis detection.

Figure 1.

Flow chart of study identification, screening, inclusion, and exclusion for meta‑analysis.

Figure 2.

Quality assessment for 18 studies (Quality Assessment of Diagnostic Accuracy Studies [QUADAS]–2).

Figure 3.

Forest plots of the sensitivity and specificity for monocyte distribution width across all included studies.

Figure 4.

A, Hierarchical summary receiver operating characteristic plot of monocyte distribution width (MDW) across all included studies. B, Comparisons of MDW and procalcitonin (PCT) with summary receiver operating characteristic (ROC) curves. C, Comparisons of MDW and C‑reactive protein (CRP) with summary ROC (SROC) curves. AUC = area under the curve, DOR = diagnostic odds ratio, HSROC = hierarchical summary ROC.