Prognostic Importance of Red Cell Distribution Width, Mean Platelet Volume and Neutrophil Lymphocyte Ratio among Sepsis Patients at a Tertiary Setting in Kolar, South India

Abstract

Introduction: Complete Blood Count (CBC) analysis contain several parameters that are routinely investigated during admission. Of these parameters, Red-Cell Distribution Width (RDW), Mean Platelet Volume (MPV), Neutrophil-Lymphocyte Ratio (NLR) have been observed as independent risk factors for various systemic diseases. Aim: To compare the prognostic value of RDW, MPV, NLR with Sequential Organ Failure Assessment (SOFA) score among sepsis survivors and non survivors. Materials and Methods: A prospective observational study was conducted among 120 sepsis patients admitted in department of General Medicine and Intensive Care Unit (ICU) at a tertiary care and research center in Kolar, South India, for 18 months from January 2018 to July 2019. Patients information regarding age, gender, SOFA scores, and parameters like RDW, MPV, NLR were recorded from the blood sample. The SOFA score, RDW, NLR, and MPV levels were considered explanatory variables for sepsis patients’ mortality. To test significance, independent t-test and Chi-square test were used. Correlation analysis was performed with the pearson correlation coefficient. The SOFA score, RDW, MPV, and NLR were further analysed using the receiver operating characteristic (ROC). The level of significance was set at ≤0.05. coGuide software, V.1. was used for data analysis. Results: All 120 subjects were divided into two groups. Survivor’s group had 79 (65.8%) subjects, and 41 (34%) were in non-survivor’s groups. Most of the survivors were in the age group 60-79 years which were 29 (36.71%), whereas non survivors were 40-59 years which were 17 (41.46%). Maximum were males in both the groups. Fever was the most common presenting symptom in survivors, 62 (78.48%) and non survivors 31 (75.61%). The calculated Area Under Curve (AUC) for RDW was 0.973 with 90.24% sensitivity and 97.47% specificity. The AUC for MPV was 0.966 with 92.68% sensitivity and 97.47% specificity, and for NLR, it was 0.984 with 100% sensitivity and 89.87% specificity. The yielded AUC for SOFA score was 0.772 with 56.10% sensitivity and 89.87% specificity. Ventilator and ionotropic support were strongly associated between groups (p-value <0.001). There was a significant difference among survivors and non survivors for SOFA score (p-value <0.001), systolic and diastolic blood pressure, pulse rate, GCS, and investigations like RDW, NLR, and MPV (p-value <0.001). Conclusion: This study demonstrated a strong correlation between increased levels of RDW, NLR, MPV and mortality among sepsis patients and can be used as prognostic markers for mortality prediction in adult sepsis patients.

Keywords

• biomarkers
• complete blood analysis
• inflammatory marker
• systemic inflammation
• ventilation