Monocyte distribution width enhances the detection of infection in patients after primary percutaneous coronary intervention

BACKGROUND: Monocyte distribution width (MDW) may serve as an infection marker in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), where infection rates range from 2.4% to 16.6%. We evaluated the association of increased MDW levels with infection occurrence and to assess MDW-based models for predicting infection risk and prolonged hospital length of stay (LOS) ≥ 7 days. METHODS AND RESULTS: This retrospective cohort study included AMI patients undergoing PCI at a Taiwanese tertiary teaching hospital from January 1, 2020, to September 30, 2021. Logistic regression models incorporating MDW, Quick Sequential Organ Failure Assessment (qSOFA) score, age, and C-reactive protein (CRP) levels were compared to the Canada Acute Coronary Syndrome (C-ACS) score and stress hyperglycemia ratio (SHR). Among 252 patients, 12.7% developed infections, a rate that falls within the expected range. Infections were more frequent among patients with LOS ≥ 7 days (42.9% vs. 1.1%). A three-parameter model (qSOFA score ≥2, age ≥ 65, and MDW ≥ 20) demonstrated good performance for new infection (AUC: 0.834) and LOS ≥ 7 days (AUC: 0.714). Adding CRP ≥ 2 mg/dL improved predictions for infection (AUC: 0.909) and LOS ≥ 7 days (AUC: 0.798), outperforming the C-ACS score (AUC: 0.807) and SHR (AUC: 0.784). CONCLUSION: MDW emerges as a promising biomarker for assessing the risks of infection and prolonged hospital LOS in patients with AMI. Its early use may facilitate timely clinical interventions, including earlier initiation of antibiotic therapy.