Digestive diseases and sciences · 2026
Monocyte Distribution Width Differentiates Bacterial Enterocolitis from Acute Severe Ulcerative Colitis in the Emergency Department.
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Li Wai Suen Christopher F D, Kaul Shipraa, Tan Ethan X Z, Con Danny, Taylor Michelle, Wiid Joanne, Hogan Chris, Choy Matthew C, Visvanathan Kumar, De Cruz Peter
Аннотация
PURPOSE: Differentiating bacterial enterocolitis from acute severe ulcerative colitis (ASUC) is a common diagnostic problem. Monocytes play a role in the pathogenesis of ulcerative colitis and show variation in size, which is measurable as monocyte distribution width (MDW). We aimed to assess whether MDW can differentiate bacterial enterocolitis from ASUC and predict therapeutic response in ASUC.
METHODS: We conducted a retrospective cohort study comprising three patient groups: ASUC, bacterial enterocolitis, and controls at a tertiary Australian center. MDW, routine biomarkers and clinical outcomes were recorded. Primary outcomes included the difference in MDW between patient groups and the performance of MDW in distinguishing ASUC from bacterial enterocolitis. Secondary outcomes included the prediction of treatment response in ASUC and the performance in identifying biochemical remission post-ASUC.
RESULTS: 176 patients were identified (53 ASUC, 70 bacterial enterocolitis and 53 controls). At presentation, patients with bacterial enterocolitis had the highest MDW (median 23.6, IQR 20.7-25.8) compared to ASUC (19.0, IQR 17.9-21.2; P < 0.001) and controls (16.8, IQR 15.9-18.0; P < 0.001). MDW discriminated bacterial enterocolitis from ASUC (Area under the curve [AUC]: 0.78, 95% CI: 0.70-0.87, P < 0.001). In ASUC, MDW correlated with CRP and fecal calprotectin. MDW on the day of infliximab administration predicted infliximab response (AUC: 0.80, 95% CI: 0.61-1.0, P = 0.002). Three months post-ASUC, MDW identified biochemical remission (fecal calprotectin < 100 µg/g; AUC 0.80, 95% CI: 0.64-0.95, P < 0.001).
CONCLUSION: MDW is a novel biomarker that may help distinguish ASUC from bacterial enterocolitis. In patients with ASUC, MDW may predict inpatient infliximab response and identify biochemical remission at 3 months. Validation is required to confirm its utility.
METHODS: We conducted a retrospective cohort study comprising three patient groups: ASUC, bacterial enterocolitis, and controls at a tertiary Australian center. MDW, routine biomarkers and clinical outcomes were recorded. Primary outcomes included the difference in MDW between patient groups and the performance of MDW in distinguishing ASUC from bacterial enterocolitis. Secondary outcomes included the prediction of treatment response in ASUC and the performance in identifying biochemical remission post-ASUC.
RESULTS: 176 patients were identified (53 ASUC, 70 bacterial enterocolitis and 53 controls). At presentation, patients with bacterial enterocolitis had the highest MDW (median 23.6, IQR 20.7-25.8) compared to ASUC (19.0, IQR 17.9-21.2; P < 0.001) and controls (16.8, IQR 15.9-18.0; P < 0.001). MDW discriminated bacterial enterocolitis from ASUC (Area under the curve [AUC]: 0.78, 95% CI: 0.70-0.87, P < 0.001). In ASUC, MDW correlated with CRP and fecal calprotectin. MDW on the day of infliximab administration predicted infliximab response (AUC: 0.80, 95% CI: 0.61-1.0, P = 0.002). Three months post-ASUC, MDW identified biochemical remission (fecal calprotectin < 100 µg/g; AUC 0.80, 95% CI: 0.64-0.95, P < 0.001).
CONCLUSION: MDW is a novel biomarker that may help distinguish ASUC from bacterial enterocolitis. In patients with ASUC, MDW may predict inpatient infliximab response and identify biochemical remission at 3 months. Validation is required to confirm its utility.