Monocyte anisocytosis increases during multisystem inflammatory syndrome in children with cardiovascular complications

Lael M. Yonker, Oluwakemi Badaki-Makun, Puneeta Arya, Brittany P. Boribong, Gabriela Moraru, Brittany Fenner, Jaimar Rincon, Alex Hopke, Brent Rogers, Jeremiah Hinson, Alessio Fasano, Lilly Lee, Sarah M. Kehoe, Shawn D. Larson, Hector Chavez, Scott Levin, Lyle L. Moldawer, Daniel Irimia

Research output: Contribution to journalArticlepeer-review


Background: Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication that can develop weeks to months after an initial SARS-CoV-2 infection. A complex, time-consuming laboratory evaluation is currently required to distinguish MIS-C from other illnesses. New assays are urgently needed early in the evaluation process to expedite MIS-C workup and initiate treatment when appropriate. This study aimed to measure the performance of a monocyte anisocytosis index, obtained on routine complete blood count (CBC), to rapidly identify subjects with MIS-C at risk for cardiac complications. Methods: We measured monocyte anisocytosis, quantified by monocyte distribution width (MDW), in blood samples collected from children who sought medical care in a single medical center from April 2020 to October 2020 (discovery cohort). After identifying an effective MDW threshold associated with MIS-C, we tested the utility of MDW as a tier 1 assay for MIS-C at multiple institutions from October 2020 to October 2021 (validation cohort). The main outcome was the early screening of MIS-C, with a focus on children with MIS-C who displayed cardiac complications. The screening accuracy of MDW was compared to tier 1 routine laboratory tests recommended for evaluating a child for MIS-C. Results: We enrolled 765 children and collected 846 blood samples for analysis. In the discovery cohort, monocyte anisocytosis, quantified as an MDW threshold of 24.0, had 100% sensitivity (95% CI 78–100%) and 80% specificity (95% CI 69–88%) for identifying MIS-C. In the validation cohort, an initial MDW greater than 24.0 maintained a 100% sensitivity (95% CI 80–100%) and monocyte anisocytosis displayed a diagnostic accuracy greater that other clinically available hematologic parameters. Monocyte anisocytosis decreased with disease resolution to values equivalent to those of healthy controls. Conclusions: Monocyte anisocytosis detected by CBC early in the clinical workup improves the identification of children with MIS-C with cardiac complications, thereby creating opportunities for improving current practice guidelines.

Original languageEnglish (US)
Article number563
JournalBMC infectious diseases
Issue number1
StatePublished - Dec 2022


  • Monocyte distribution width
  • Multisystem inflammatory syndrome in children
  • Pediatric COVID-19

ASJC Scopus subject areas

  • Infectious Diseases


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