A Prospective Observational Study of qSOFA Score Combined With Initial Red Cell Distribution Width as a Diagnostic Indicator of 30 Days Mortality in Patients With Infection at Emergency Department

Abstract

Introduction: Sepsis is a major cause of morbidity and mortality in emergency settings. Quick Sequential Organ Failure Assessment (qSOFA) is a bedside tool used to identify high-risk patients. Red cell distribution width (RDW), a routinely available haematological parameter, has been linked to adverse outcomes in various critical conditions. This study explores the association between qSOFA combined with RDW and 30-day mortality in infected patients presenting to the emergency department.Methods: A prospective observational study was conducted from 2023 to 2024 in the Emergency Department of Rajiv Gandhi Government General Hospital, Chennai. A total of 100 adult patients with suspected infection or sepsis were enrolled. Patients with nutritional anaemia, red blood cell disorders, immune compromised states, or terminal malignancy were excluded. Vital signs and Glasgow Coma Scale were recorded t calculate qSOFA. RDW was stratified into three groups: 12–14%, 14–14.9%, and ≥15%. Patients were followed for 30 days, and outcomes were categorized as discharged or expired. Statistical analysis including chi-square, t-tests, sensitivity/specificity, and ROC curves was performed using SPSS.Results: Among 100 patients, 82% expired, and 18% were discharged. Higher qSOFA scores (score 3: 91% mortality) and elevated RDW (>15%: 93.3% mortality) were significantly associated with poor outcomes. The combinationof qSOFA ≥2 and RDW >15% showed the highest predictive value for mortality (97% mortality, p<0.05). ROC curve analysis yielded an AUC of 0.52 for the combined score, indicating limited but suggestive predictive value.Conclusion: qSOFA score combined with RDW is significantly associated with 30-day mortality in patients presenting with infection. While RDW alone had moderate predictive strength, its integration with qSOFA enhanced mortality prediction. Given its availability and cost-effectiveness, RDW may serve as a valuable adjunct in early sepsis risk stratification.