European MDW Advisory Board Makes Recommendations

Sepsis is a prevalent, deadly, yet often elusive condition in emergency departments worldwide. Diagnosing sepsis — especially in patients presenting mild and non-specific initial symptoms – challenges both clinical gestalt and institutional protocols, as use of biomarkers for early sepsis detection has been controversial and their utilization varies widely across countries and institutions.

Last month, a panel of international thought leaders on sepsis came together to discuss the clinical utility and build a consensus view on the clinical application of Monocyte Distribution Width (MDW)* in the context of pan-European and country-specific standards of sepsis care.
  
The panelists represented eight different European countries including the United Kingdom, Monaco, Spain, France, the Czech Republic, Italy, Belgium and Germany. The group of physicians and professors, representing major institutions, came together under the leadership of Professor Pierre Hausfater from Hôpital Pitié-Salpêtrière and Sorbonne Université, in Paris, France.

During the two-day, virtual meeting, a consensus emerged amongst the experts that MDW is an important, sensitive and relatively inexpensive tool in the early screening of adult patients as it can indicate the probability of sepsis or severe infection in the emergency department, when used together with clinical signs and symptoms. 

"MDW is a very good sepsis triage test and in our studies, we confirmed that MDW can significantly improve the value of the screening criteria," said Prof. Hausfater. "In patients where the clinical suspicion is low, MDW could represent a warning signal to the physician that the patient has a higher probability of systemic infection or sepsis," he added. 

The panelists agreed this is consistent with understanding of monocytes physiology and behavior, pointing to the key role of monocytes in both innate and adaptive immune response and the importance to detect increased functional and morphological heterogeneity of monocytes in systemic infection and in sepsis. This, according to the expert panel consensus can be precisely done with MDW. 

They also concurred that the results are quickly available in the initial clinical assessment as part of CBC-Diff² for all emergency department-comers, without change to the current workflow. 

Additionally, the panelist agreed that MDW can be used as a screening tool for severe infection or sepsis irrespective of causative agent, whether it is bacterial, viral, or fungal. 

Used together with clinical signs and standard of care to improve the accuracy of sepsis or severe infection diagnosis, they concluded that MDW could alert physicians to patients whom they do not suspect have infection, or significantly increase the level of suspicion for patients who may present with vague or non-specific symptoms. They concluded that MDW could also alert physicians to patients considered to have low risk of systemic infection/sepsis.

"MDW is a simple test and quickly available, and it is included in a very commonly requested laboratory test, the CBC with differential," shared Professor Jean-Louis Vincent. "We can say that whenever there is any possibility of an infection, we need to use MDW together with the white blood cell count, CRP and, perhaps, Procalcitonin," he concluded. 

To learn more about MDW as a biomarker for the early detection of sepsis in the emergency department, watch the ACEP20 recording with Prof. Pierre Hausfater and Dr. Tiffany M. Osborn.