Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 27 , ISSUE 5 ( May, 2023 ) > List of Articles


Association of Monocyte Distribution Width with the Need for Respiratory Support in Hospitalized COVID-19 Patients

Kiattichai Daorattanachai, Chachchom Hirunrut, Pattarin Pirompanich, Sinee Weschawalit, Winchana Srivilaithon

Keywords : COVID-19, High-flow nasal cannula, Mechanical ventilation, Mortality, Monocyte distribution width, Respiratory support

Citation Information : Daorattanachai K, Hirunrut C, Pirompanich P, Weschawalit S, Srivilaithon W. Association of Monocyte Distribution Width with the Need for Respiratory Support in Hospitalized COVID-19 Patients. Indian J Crit Care Med 2023; 27 (5):352-357.

DOI: 10.5005/jp-journals-10071-24447

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: The monocyte distribution width (MDW), a novel inflammatory biomarker reflecting morphological changes in response to inflammation, has been shown to be useful in identifying COVID-19 infection or predicting death. However, data on the association with predicting the need for respiratory support are still limited. The aim of this study was to determine the association of MDW with the need for respiratory support in patients with SARS-CoV-2 infection. Patients and methods: This is a single-center retrospective cohort study. Consecutive hospitalized COVID-19 adult patients who presented at the outpatient department (OPD) or emergency department (ED) between May and August 2021 were enrolled. Respiratory support was defined as any one of the following: conventional oxygen therapy, high-flow oxygen nasal cannula, noninvasive, or invasive mechanical ventilation. The performance of MDW was measured using the area under the receiver operating characteristic (AuROC) curve. Results: Of the 250 enrolled patients, 122 (48.8%) patients received respiratory support. The mean MDW was significantly higher in the respiratory support group: 27.2 ± 4.6 vs 23.6 ± 4.1 (p < 0.001). The MDW ≥ 25 had the best AuROC characteristics of 0.70 (95% CI: 0.65–0.76). Conclusions: The MDW is a potential biomarker that may aid in identifying individuals at risk of requiring oxygen support in COVID-19 and can be easily implemented in clinical practice.

PDF Share
  1. Xiao LN, Ran X, Zhong YX, Li SS. Clinical value of blood markers to assess the severity of coronavirus disease 2019. BMC Infect Dis 2021;21(1):921. DOI: 10.1186/s12879-021-06623-5.
  2. Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisations: Systematic review and meta-analysis. BMJ Evid Based Med 2021;26(3):107–108. DOI: 10.1136/bmjebm-2020-111536.
  3. Hausfater P, Robert Boter N, Morales Indiano C, Cancella de Abreu M, Marin AM, Pernet J, et al. Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: Comparison with CRP and procalcitonin in a multicenter international European prospective study. Crit Care 2021;25(1):227. DOI: 10.1186/s13054-021-03622-5.
  4. Li C-H, Seak C-J, Chaou C-H, Su T-H, Gao S-Y, Chien C-Y, et al. Comparison of the diagnostic accuracy of monocyte distribution width and procalcitonin in sepsis cases in the emergency department: A prospective cohort study. BMC Infect Dis 2022;22(1):26. DOI: 10.1186/s12879-021-06999-4.
  5. Riva G, Castellano S, Nasillo V, Ottomano AM, Bergonzini G, Paolini A, et al. Monocyte distribution width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients. Sci Rep 2021;11(1):12716. DOI: 10.1038/s41598-021-92236-6.
  6. Alsuwaidi L, Al Heialy S, Shaikh N, Al Najjar F, Seliem R, Han A, et al. Monocyte distribution width as a novel sepsis indicator in COVID-19 patients. BMC Infect Dis 2022;22(1):27. DOI: 10.1186/s12879-021-07016-4.
  7. Zeng X, Xing H, Wei Y, Tang Z, Lu X, Wang Z, et al. Monocyte volumetric parameters and lymph index are increased in SARS-CoV-2 infection. Int J Lab Hematol 2020;42(6):e266–e269. DOI: 10.1111/ijlh.13323.
  8. Ognibene A, Lorubbio M, Magliocca P, Tripodo E, Vaggelli G, Iannelli G, et al. Elevated monocyte distribution width in COVID-19 patients: The contribution of the novel sepsis indicator. Clin Chim Acta 2020;509:22–24. DOI: 10.1016/j.cca.2020.06.002.
  9. Lorubbio M, Tacconi D, Iannelli G, Feri M, Scala R, Montemerani S, et al. The role of monocyte distribution width (MDW) in the prognosis and monitoring of COVID-19 patients. Clin Biochem 2022;103:29–31. DOI: 10.1016/j.clinbiochem.2022.02.007.
  10. Daorattanachai K, Benjapongvimol V, Srivilaithon W, Thavaraputta S. Performance of rapid, antigen-detecting point-of-care test for suspected SARS-CoV-2 patients presented to the Emergency Department. Sci Technol Asia 2002;27(4):69–76. Retrieved from
  11. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving sepsis campaign: Guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 2020;46(5):854–887. DOI: 10.1007/s00134-020-06022-5.
  12. Jakubzick CV, Randolph GJ, Henson PM. Monocyte differentiation and antigen-presenting functions. Nat Rev Immunol 2017;17(6):349–362. DOI: 10.1038/nri.2017.28.
  13. Martinez FO, Combes TW, Orsenigo F, Gordon S. Monocyte activation in systemic Covid-19 infection: Assay and rationale. EBioMedicine 2020;59:102964. DOI: 10.1016/j.ebiom.2020.102964.
  14. Zonneveld R, Molema G, Plötz FB. Analyzing neutrophil morphology, mechanics, and motility in sepsis: Options and challenges for novel bedside technologies. Crit Care Med 2016;44(1):218–228. DOI: 10.1097/CCM.0000000000001266.
  15. Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito NPH, et al. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med 2021;41:110–119. DOI: 10.1016/j.ajem.2020.12.076.
  16. Singh S, Singh K. Blood urea nitrogen/albumin ratio and mortality risk in patients with COVID-19. Indian J Crit Care Med 2022;26(5):626–631. DOI: 10.5005/jp-journals-10071-24150.
  17. Seyit M, Avci E, Nar R, Senol H, Yilmaz A, Ozen M, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. Am J Emerg Med 2021;40:110–114. DOI: 10.1016/j.ajem.2020.11.058.
  18. Xia W, Tan Y, Hu S, Li C, Jiang T. Predictive value of systemic immune-inflammation index and neutrophil-to-lymphocyte ratio in patients with severe COVID-19. Clin Appl Thromb Hemost 2022;28: 10760296221111391. DOI: 10.1177/10760296221111391.
  19. Kim SW, Lee H, Lee SH, Jo SJ, Lee J, Lim J. Usefulness of monocyte distribution width and presepsin for early assessment of disease severity in COVID-19 patients. Medicine (Baltimore) 2022;101(27):e29592. DOI: 10.1097/MD.0000000000029592.
  20. Crouser ED, Parrillo JE, Seymour CW, Angus DC, Bicking K, Esguerra VG, et al. Monocyte distribution width: A novel indicator of sepsis-2 and sepsis-3 in high-risk Emergency Department patients. Crit Care Med 2019;47(8):1018–1025. DOI: 10.1097/CCM.0000000000003799.
  21. Lin HA, Lin SF, Chang HW, Lee YJ, Chen RJ, Hou SK. Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study. PLoS One 2020;15(11):e0241262. DOI: 10.1371/journal.pone.0241262.
  22. Lin S-F, Lin H-A, Chuang H-C, Tsai H-W, Kuo N, Chen S-C, et al. Fever, tachypnea, and monocyte distribution width predicts length of stay for patients with COVID-19: A pioneer study. J Pers Med 2022;12(3):449. DOI: 10.3390/jpm12030449.
  23. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med 2020;180(10):1345–1355. DOI: 10.1001/jamainternmed.2020.3539.
  24. Gupta D, Jain A, Chauhan M, Dewan S. Inflammatory markers as early predictors of disease severity in COVID-19 patients admitted to intensive care units: A retrospective observational analysis. Indian J Crit Care Med 2022;26(4):482–486. DOI: 10.5005/jp-journals-10071-24171.
  25. Lu L, Zhong W, Bian Z, Li Z, Zhang K, Liang B, et al. A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis. J Infect 2020;81(4):e18–e25. DOI: 10.1016/j.jinf.2020.07.002.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.