TOPLINE:

Upon presentation to the emergency department (ED), the monocyte distribution width (MDW) derived from routine full blood examinations could effectively differentiate acute severe ulcerative colitis (UC) from bacterial enterocolitis.

METHODOLOGY:

• MDW is a hematologic parameter that reflects variation in monocyte size; it has been proposed as a tool for early diagnosis of sepsis in the ED and as a prognostic indicator in COVID, but its role in inflammatory disorders has not been well studied.
• Researchers conducted a retrospective cohort study at a tertiary hospital in Australia to evaluate whether MDW could distinguish acute severe UC from bacterial enterocolitis.
• They identified 176 patients and divided them into three groups: those who presented to the ED with acute severe UC (n = 53), those who presented with diarrhea due to bacterial enterocolitis (n = 70), and those with chronic hepatitis B in the immune control phase without active inflammation (control group; n = 53).
• MDW was measured on routine full blood examinations using a hematology analyzer; data on routine laboratory and clinical outcomes were extracted from hospital records.
• Primary outcomes were between-group differences in MDW at presentation to the ED and the ability of MDW to discriminate acute severe UC from bacterial enterocolitis.

TAKEAWAY:

• At presentation to the ED, MDW was higher in patients with bacterial enterocolitis (median, 23.6) than in those with acute severe UC (median, 19.0; P < .001) and in the control group (median, 16.8; P < .001).
• MDW discriminated bacterial enterocolitis from acute severe UC, with an area under the receiver operating characteristic curve of 0.78 (P < .001).
• After adjusting for age and sex, each 1-unit increase in MDW was associated with 38% higher odds of bacterial enterocolitis vs acute severe UC (odds ratio, 1.38; 95% CI, 1.20-1.60); an MDW threshold of ≥ 22.3 yielded 64.3% sensitivity and 84.6% specificity for bacterial enterocolitis.
• In patients with acute severe UC, MDW correlated positively with established markers of disease activity, and although it did not predict initial steroid response, a lower MDW at presentation and immediately before infliximab administration predicted response to infliximab in steroid-refractory patients.

IN PRACTICE:

“MDW can help discriminate bacterial enterocolitis from ASUC [acute severe UC] and may help improve patient care by prompting early initiation of empirical antibiotics. In addition, we identified MDW as a novel biomarker of disease activity in UC, with potential utility in identifying patients at risk of failing infliximab rescue therapy in ASUC,” the authors of the study wrote.

SOURCE:

The study was led by Christopher F.D. Li Wai Suen, University of Melbourne, Melbourne, Australia. It was published online in Digestive Diseases and Sciences.

LIMITATIONS:

The retrospective study was conducted at a single center in Australia, limiting the generalizability. The control group consisted of patients with chronic hepatitis B in the immune control phase rather than healthy adults. The exclusion of patients with UC and concomitant bacterial enterocolitis, although intended to reduce confounding, limited insight into MDW behavior in mixed inflammatory and infectious presentations.

DISCLOSURES:

The study did not receive any external funding. Some authors reported receiving educational support and research funding from charitable foundations, institutional endowments, philanthropic sources, and industry; several authors were supported by Australian government postgraduate scholarships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.