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Research article
The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal
Rajan Ghimire
Nick Simmons Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5095-8477
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: 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 several 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.
Methods: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among 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.
Results: RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818; p-value=0.000) as 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 group analysis showed no mortality in RDW <13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to >15.6 RDW group and 45.9% mortality in >15.6 RDW group. Significant mortality difference was seen in 14 to >15.6 and >15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively.
Conclusion: Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.
Keywords
red cell distribution width, sepsis, emergency care, mortality
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On 29 Mar, 2020
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Received 12 Mar, 2020
Reviewer #2 agreed
On 01 Mar, 2020
Review #1 received
Received 27 Feb, 2020
Reviewers invited
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Reviewer #1 agreed
On 25 Feb, 2020
Editor assigned
On 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
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Review #2 received
Received 07 Feb, 2020
Editorial decision: Major revision
On 07 Feb, 2020
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Received 23 Jun, 2019
Reviewer #2 agreed
On 20 Jun, 2019
Reviewers invited
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Reviewer #1 agreed
On 09 Jun, 2019
Editor assigned
On 04 Jun, 2019
Submission checks complete
On 03 Jun, 2019
Editor invited
On 03 Jun, 2019
First submitted
On 23 May, 2019
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Critical Care & Emergency Medicine
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This preprint is under consideration at BMC Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal
Rajan Ghimire
Nick Simmons Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5095-8477
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 5
Posted 21 May, 2020
No community comments so far
Submission checks complete
On 14 May, 2020
No comments provided
Editorial decision: Minor revision
On 10 May, 2020
Review #1 received
Received 01 May, 2020
Reviewer #1 agreed
On 14 Apr, 2020
Reviewers invited
Invitations sent on 13 Apr, 2020
Editor assigned
On 08 Apr, 2020
Editor invited
On 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 01 Apr, 2020
Review #1 received
Received 31 Mar, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Editor assigned
On 30 Mar, 2020
Submission checks complete
On 29 Mar, 2020
Editor invited
On 29 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 16 Mar, 2020
Review #2 received
Received 12 Mar, 2020
Reviewer #2 agreed
On 01 Mar, 2020
Review #1 received
Received 27 Feb, 2020
Reviewers invited
Invitations sent on 25 Feb, 2020
Reviewer #1 agreed
On 25 Feb, 2020
Editor assigned
On 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
No comments provided
Review #2 received
Received 07 Feb, 2020
Editorial decision: Major revision
On 07 Feb, 2020
Review #1 received
Received 23 Jun, 2019
Reviewer #2 agreed
On 20 Jun, 2019
Reviewers invited
Invitations sent on 09 Jun, 2019
Reviewer #1 agreed
On 09 Jun, 2019
Editor assigned
On 04 Jun, 2019
Submission checks complete
On 03 Jun, 2019
Editor invited
On 03 Jun, 2019
First submitted
On 23 May, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: 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 several 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.
Methods: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among 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.
Results: RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818; p-value=0.000) as 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 group analysis showed no mortality in RDW <13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to >15.6 RDW group and 45.9% mortality in >15.6 RDW group. Significant mortality difference was seen in 14 to >15.6 and >15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively.
Conclusion: Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.
Figure 1
Figure 2