ABSTRACT
Introduction As part of the ' Lotta alla sepsi -Call to Action' project of the ARS (Regional Health Agency) of Tuscany, a study was undertaken on sepsis which had the aim of evaluating the biomarker MDW (Monocyte distribution width) of all enrolled patients of the PS with suspected sepsis. MDW is a hematological parameter that measures the dispersion around the mean of the monocyte volume population and has been proposed as an early indicator of sepsis. Given the timeliness and ease of measurement with complete blood count (CBC), MDW can quickly help the clinician in risk stratification. Patients who tested positive for Covid-19 were also enrolled during the study. This contribution reports on how the MDW biomarker behaves in patients with similar presentation who may progress to sepsis or Covid-19. Materials and methods For the study, 397 patients (178 F + 219 M) aged between 18 and 98 years (mean 62.6 SD ± 21.7) were enrolled by the Emergency Department of the San Donato Hospital in Arezzo between 5 July 2019 and 30 April 2020 with suspected sepsis. Of these, 133 tested positive and 264 negative for the nasopharyngeal molecular swab for SARS-CoV-2. Diagnostic stratification for sepsis was performed according to the definition of Sepsis-3. Complete blood count (CBC), which includes MDW, was performed on the UniCel DxH 900 analyzer (Beckman Coulter) using whole blood collected in tubes with K2 EDTA anticoagulant. Data analysis was performed by IBM SPSS statistics version 20.0 (SPSS, Chicago, IL). Results For Covid-19 patients, MDW AUC is 0.85 (95% CI 0.80-0.90) and PCT (procalcitonin) AUC is 0.81 (95% CI 0.75-0.87). The PCT at the cutoff of 0.5 ng / mL had a sensitivity of 13% and specificity of 92%, while the MDW at the cutoff of 22 had a sensitivity of 86% and specificity of 74%. In patients with sepsis MDW AUC is 0.83 (95% CI 0.76-0.90) and PCT AUC is 0.84 (95% CI 0.78-0.91). The PCT at the cutoff of 0.5 ng / mL showed a sensitivity of 66% and specificity of 82%, while the MDW at the cutoff of 22 had a sensitivity and specificity of 90% and 55% respectively. Conclusion In both sepsis and Covid-19 infection, the two parameters convey different information and have complete effectiveness in terms of sensitivity and specificity.