The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal [post]

2020 unpublished
: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has a number of variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis. Method: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital
more » ... ng the patients age ≥16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method. Result: RDW is more efficacious test to predict mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818; p-value=0.000) than APACHE II (AUC of 0.728; 95% C. I= 0.637 to 0.819; p-value=0.000) or SOFA (AUC of 0.680, 95% C.I =0.591-0.770; p-value=0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio=1.81) and specificity of 54% (negative likelihood ratio=0.32). Out of 44 patients with septic shock 16 died (36.4 %) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p=0.555, 95% C. I= 0.231-2.194). Overall mortality was 27.02% (n=40). RDW subgroup analysis showed no mortality in low RDW (<13.1) subgroup, 3.6% mortality in moderate (13.1 to 14) RDW group, 22.0% mortality in high (14 to >15.6) RDW group and 45.9% mortality in very high (>15.6) RDW group. Significant mortality difference was seen in high and very high RDW subgroups with a p-value of 0.003 and 0.008 respectively. Conclusion: RDW can be used as a good prognostic score to predict the mortality of patients with sepsis in the emergency room. RDW is a more efficacious test to predict mortality in sepsis than APACHE II or SOFA scores.
doi:10.21203/rs.2.10110/v2 fatcat:kdrlp72tu5b7pfhuxhz6qdecje