A study of the prognostic value of red cell distribution width and neutrophil: lymphocyte ratio in adults with sepsis

  • Dr. Rohit K Patel Junior resident, Department of medicine, Dr. VVP RMC, Loni
  • Dr. K M Raul Professor, Department of medicine, Dr. VVP RMC, Loni
  • Dr. Anandulal P. P. Medical officer, Dr. VVP RMC, Loni
  • Dr. Rushabh N. Lunawat Junior resident, Department of medicine , Dr. VVP RMC , Loni
Keywords: Sepsis, Intensive Care Units (ICU), neutrophil: lymphocyte ratio, oxygen requirements


Introduction: Sepsis continues to be a major cause of morbidity and mortality in Intensive Care Units (ICU) despite the better understanding of its pathophysiology in recent years. This may manifest as organ dysfunction such as hypotension, altered mental status, abnormal coagulation, increase in bilirubin levels, deranged renal function and increase in oxygen requirements. With this background, the current study of the relationship between RDW and neutrophil: lymphocyte ratio with severity of illness in patients admitted to medical ICUs with sepsis, has been undertaken.

Objectives: To study the prognostic value of red cell distribution width and neutrophil: lymphocyte ratio in sepsis.

Materials and Methods: This study was conducted on adult patients, who were admitted in ICUs of Tertiary care hospitals attached to Dr. VVP RMC, Loni, Maharashtra and whose haematological investigations were done within 24 hours of ICU admission. Patients with haematological disorders, immunocompromised patients, patients whose haematological investigations were not done within 24 hours of admission and who were not admitted in ICU were excluded from the study. The study was conducted for a two-year timespan, from September 2020 to September 2022. On admission, patients were stratified according to q-SOFA scoring10   and SOFA score were calculated. Haematological investigations were done within 24 hours of admission. q-SOFA score and SOFA score were calculated at the fifth day of admission to ICU, to assess progress of the patient.

Results: Majority of the patients with sepsis were over 50 years of age. Hypertension, diabetes and obstructive airway diseases were the most common comorbidities present in the patients that were present in the study. Pulmonary infections were the most common source of infection in majority of sepsis cases, followed by tropical/ non- localised infections. RDW was found to be between 14.2 and 15.2 in majority of patients with sepsis in the study group. It was found that higher the RDW, higher the q-SOFA score and worse is the outcome at the end of 5 days. RDW at admission vs Outcomes assessed using ANOVA obtained a p value of p<0.0001 (highly significant). Patients with worse outcomes had a high RDW at admission. NLR vs q-SOFA assessed using Kruskal Wallis and then checked using Mann Whitney U test showed a significant p value of 0.006. It was found in the study that as the q-SOFA score increases, median NLR increases.

Conclusion: The study implies that patients with sepsis having an RDW more than 15.050 may benefit from early interventions and more aggressive management. In low resource settings, the RDW, in the emergency department could afford the earliest opportunity to identify patients at risk of bacteremia and the administration of antimicrobials at the appropriate time.


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DOI: 10.26838/MEDRECH.2022.9.6.636
Published: 2022-11-12
How to Cite
Patel RK, Raul KM, Anandulal PP, Lunawat RN. A study of the prognostic value of red cell distribution width and neutrophil: lymphocyte ratio in adults with sepsis. Med. res. chronicles [Internet]. 2022Nov.12 [cited 2022Nov.26];9(6):385-9. Available from: https://medrech.com/index.php/medrech/article/view/613
Original Research Article