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Background Sepsis is common problem encountered in emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency room using present scores which has numbers of variables to calculate. Red cell distribution width (RDW) is easy, cheap and efficacious score to predict severity and mortality of patients with sepsis. Method This prospective analytical study was conducted in emergency room of Tribhuvan University Teaching Hospital among patients of age ≥16 years with clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in study by using nonprobability 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) than APACHE II (AUC of 0.728; 95% C. I= 0.637 to 0.819) or SOFA (AUC of 0.680, 95% C.I =0.591-0.770). Cutoff of RDW 15.05 has sensitivity of 73% (positive likelihood ratio 1.82) and specificity of 60% (negative likelihood ratio 0.45) while cutoff of RDW 16.1 has Sensitivity of 56% (PLR 2.07) and specificity of 73% (NLR 0.6). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock,24 died (22.9%) with 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 (15.6) RDW group and 45.9% mortality in very high (>15.6) RDW group. Significant mortality difference seen in high and very high RDW subgroup with p value 0.003 and 0.008 respectively. Conclusion RDW is more efficacious test to predict mortality in sepsis than APACHE II or SOFA. Cutoff of RDW 15.05 has sensitivity of 73% and specificity of 60%. So RDW can be used as a good prognostic score to predict severity and mortality of patients with sepsis in emergency room. |
