Abstract
Sepsis remains a leading cause of childhood morbidity and mortality, particularly in low- and middle-income countries. Early identification of children at greater risk of an adverse outcome is essential, but specialised biomarkers are often unavailable in resource-limited settings. Red cell distribution width (RDW), a routinely reported component of the complete blood count, has emerged as a marker of systemic inflammation and oxidative stress and may carry prognostic value in sepsis. The prtesent study was conducted to evaluate the prognostic significance of admission RDW in children with clinically diagnosed sepsis. This prospective observational study enrolled 120 children, aged 1 month to 12 years, with a clinical diagnosis of sepsis admitted to a tertiary care hospital over a 12-month period. Admission RDW values were recorded and analysed in relation to need for intensive care, length of hospital stays and in-hospital mortality. Patients were dichotomised into survivors and non-survivors for comparative analysis, and a threshold of 15% was used to assess associations between RDW and severity indicators. Mean admission RDW was significantly higher in non-survivors than in survivors (16.6 ± 2.0% vs. 14.3 ± 1.5%; p < 0.001). Children with RDW ≥ 15% had significantly higher rates of intensive care unit (ICU) admission (60.9% vs. 24.3%; p < 0.001) and in-hospital mortality (52.2% vs. 10.8%; p < 0.001) than those with RDW < 15%, and admission RDW was positively correlated with duration of hospital stay (p < 0.001). Admission RDW is a simple, inexpensive and clinically informative parameter that is associated with disease severity and mortality in pediatric sepsis. Its routine incorporation into initial assessment may aid early risk stratification, particularly in resource-constrained settings.
Keywords: Sepsis; Red cell distribution width; Pediatric sepsis; Prognostic marker; Mortality; Critical illness.