MDW IN COVID-19

BACKGROUND: Sepsis is a major cause of mortality in hospitalization, and better recognition could lead to improved prognosis in critically-ill patients. This study evaluated the use of monocyte distribution width (MDW) to diagnose and predict the prognosis of patients with sepsis in the setting of Covid-19 infections. METHODS: This is a retrospective, observational, single-center cohort study of adult patients with confirmed COVID-19 requiring hospital admission over a 14 month period. MDW was evaluated as a biomarker to predict disease severity, determination of sepsis, and prediction of inpatient mortality. Additionally, it was compared to existing inflammatory markers including ferritin, d-dimer, and procalcitonin. RESULTS: Average MDW was found to be significantly higher in the detection of sepsis (25.50 ± 5.93) vs. patients without (23.13 ± 4.46). An MDW value of 24.9 was shown to be the best cut-off value in determining fatal outcomes;ROC curve analysis revealed an AUC value of 0.69 (95%CI: 0.55- 0.71) with a sensitivity of 83% and specificity of 71%. A Chi-square test was performed, which detected a significant association between MDW values and clinical outcome of Covid-19 (OR =3.52, 95% CL 1.78-7.11, p <0.001). MDW did not correlate with any of the existing inflammatory markers. CONCLUSIONS: MDW is a novel and reliable biomarker in identifying sepsis in patients with Covid-19 infection. High MDW values are associated with a mortality rate or absolute risk of about 25%. MDW is easily obtained from routine laboratory evaluation in the emergency room and maybe a benefit to clinical practice.

IMPLICATIONS OF FALSE POSITIVE SARS-COV-2 BY PCR TEST IN THE HEALTH CARE WORK FORCE

The novel nature of the SARS-CoV-2 virus inherently creates a paucity of reliable and validated data. Implementing evidence-based and data-driven protocols have been exceedingly difficult. As new information is released and integrated into the complex system, the health care delivery workflow must adapt. Incorporating changes on a frequent, if not daily basis, has led to confusion, frustration and loss of confidence among clinicians across the nation. This report illustrates the negative impact that false-positive COVID-19 results can have on the health delivery workforce and the emotional implications that false-positive results cast on health care providers. © 2021 by the American College of Osteopathic Family Physicians. All rights reserved.