Red Blood Cell Distribution Width (RDW) as a Predictor of 28-Day Mortality in Sepsis in ICU: A Comparison to SOFA Score in a Tertiary Care Hospital of Bangladesh
Keywords:
Sepsis, Red Blood Cell Distribution Width, SOFA score, Mortality, Intensive Care UnitAbstract
Background: Sepsis remains a primary cause of ICU admissions globally and carries high mortality rates, particularly in low- and middle-income countries (LMICs). Calculating multi-systemic scoring metrics, such as the Sequential Organ Failure Assessment (SOFA) score, can be complex and expensive in resource-limited triage settings. Red Blood Cell Distribution Width (RDW) is an automated component of routine blood counts that increases under systemic inflammation.
Objective: This study evaluated the association between admission RDW and SOFA score and compared their predictive accuracy for 28-day mortality in sepsis patients in the ICU.
Methodology: This prospective observational study followed 101 adult sepsis patients (defined by Sepsis-3 criteria with blood culture confirmation) in the general ICU of Dhaka Medical College Hospital, Bangladesh, of whom 98 completed the study. Baseline RDW levels and SOFA scores were determined within the initial 24 hours of admission or diagnosis of sepsis. Patients were tracked for 28-day mortality outcomes. Spearman’s correlation assessed parameter associations, and Receiver Operating Characteristic (ROC) curve analysis evaluated prognostic accuracy.
Results: The mean age of the patients with sepsis was 47.7±16.4 years and the majority, 54(55.1%) were male. A significant, moderate positive correlation was observed between admission RDW and SOFA scores (rs = 0.648) (p < 0.001). The crude 28-day ICU mortality rate was 45.9% (n=45). Non-survivors exhibited significantly higher median RDW (16.4% vs. 14.7%, p < 0.001) and median SOFA scores (10.0 vs. 6.0, p < 0.001) than survivors. ROC curve analysis demonstrated an Area under the Curve (AUC) of 0.961 for the SOFA score and 0.860 for RDW (p < 0.001). Using the maximum Youden Index, the optimal predictive cutoff value for RDW was 15.55% (77.8% sensitivity, 84.9% specificity) and 8.5 for the SOFA score (82.2% sensitivity, 96.2% specificity).
Conclusion: Admission RDW strongly correlates with SOFA scores and could be used to serve as an independent prognostic marker for mortality prediction in sepsis patients. While the multi-systemic SOFA score retains higher diagnostic accuracy, an RDW threshold exceeding 15.55% offers a rapid, reliable, and inexpensive triage alternative or prognostic stratification in resource-constrained clinical settings.
Bangladesh Journal of Infectious Diseases, June 2026;13(1):367-374
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Copyright (c) 2026 Suman Kundu, Manas Kanti Mazumder, Mirza Nahiduzzaman, Md. Touhidul Islam, Tumpa Kundu, Rajeebshankar Karmakar, Mohammad Monzurul Alam Bhuiyan, Abdullah Md Abu Ayub Ansary, Montosh Kumar Mondal
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Copyright on any research article in the Bangladesh Journal of Infectious Diseases is retained by the author(s).
The authors grant the Bangladesh Infection Research Association a license to publish the article and identify itself as the original publisher.
Articles in the Bangladesh Journal of Infectious Diseases are Open Access articles published under the Creative Commons CC BY-NC License (https://creativecommons.org/licenses/by-nc/4.0/)
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