Abstract：
The SARS-CoV-2 infection is characterized by both systemic and organ hyper-thromboinflammation, with a clinical course ranging from mild up-to critical systemic dysfunction and death. In patients with coronavirus disease 2019 (COVID-19) the monocyte/macrophage population is deeply involved as both trigger and target, assuming the value of useful diagnostic/prognostic marker of innate cellular immunity. Several studies correlated morphological and immunophenotypic alterations of circulating monocytes with clinical outcomes in COVID-19 patients, concluding that monocyte distribution width (MDW) may retain clinical value in stratifying the risk of disease worsening. Through an electronic search in Medline and Scopus we performed an updated literature review and meta-analysis aimed to explore the association between increased MDW levels and illness severity in COVID-19 patients, deciphering role(s) and function(s) of monocytes in the harmful network underlining SARS-CoV-2 infection. We found that significantly elevated MDW values were frequently present in COVID-19 patients who developed unfavorable clinical outcomes, compounded by a significant association between monocyte anisocytosis and SARS-CoV-2 outcomes. These findings suggest that blood MDW index and its scatter plot could represent useful routine laboratory tools for early identification of patients at higher risk of unfavorable COVID-19 and for monitoring the progression of viral infection, clinical outcomes, and therapeutic efficacy throughout hospitalization. According to this evidence, therapeutic decisions in patients with SARS-CoV-2 infection could benefit from monitoring MDW value, with administration of drugs limiting thrombo-inflammation due to monocyte hyper-activation in patients with severe/critical COVID-19 disease.
摘要：
SARS-CoV-2感染的特征是全身和器官血栓过度炎症，临床病程从轻度到严重的全身功能障碍和死亡。在2019年冠状病毒病（COVID-19）患者中，单核细胞/巨噬细胞群作为触发因子和靶标深度参与，假设先天细胞免疫的有用诊断/预后标志物的价值。多项研究将循环单核细胞的形态学和免疫表型改变与COVID-19患者的临床结果相关联，结论单核细胞分布宽度（MDW）可能在分层疾病恶化的风险方面保留临床价值。通过Medline和Scopus的电子搜索，我们进行了最新的文献综述和荟萃分析，旨在探讨COVID-19患者MDW水平升高与疾病严重程度之间的关系，破译在SARS-CoV-2感染的有害网络中单核细胞的作用和功能。我们发现，MDW值显着升高经常出现在出现不利临床结局的COVID-19患者中，单核细胞异细胞增多和SARS-CoV-2结局之间存在显著关联。这些发现表明，血液MDW指数及其散点图可以代表有用的常规实验室工具，用于早期识别处于不利的COVID-19风险较高的患者并监测病毒感染的进展，临床结果，和整个住院期间的治疗效果。根据这个证据,SARS-CoV-2感染患者的治疗决策可能受益于监测MDW值，在患有严重/危重COVID-19疾病的患者中使用限制单核细胞过度激活引起的血栓炎症的药物。
