Modified Shock Index and Red Cell Distribution Width as a Predictor of Mortality in Septic Patients in the Medical Critical Care Unit: A Five-year Retrospective Study
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Date
2024-03
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Addis Ababa University
Abstract
Background: Sepsis remains a critical public health concern, marked by elevated mortality rates
and a multifaceted clinical course. Identifying reliable predictors of patient outcomes is
imperative for optimizing the care and treatment of septic individuals. Existing clinical
parameters and scoring systems have demonstrated varying degrees of predictive accuracy in
septic patients.
Objective: To investigate the individual and combined predictive utility of modified shock index
(MSI) and red cell distribution width (RDW) in septic patients admitted to the medical intensive
care unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.
Methods: A retrospective observational study spanning four months (October 1, 2023GC, to
January 2024GC) involved a systematic review of historical medical records for adult septic
patients admitted to the medical intensive care unit from January 2019 to December 2023.
Results: Sepsis-related mortality was 40.9% (95% CI: 35.95-45.85). The results showed a
notable link between MSI and mortality. Patients with an MSI greater than 1 had a mortality odd
approximately 11.814 times higher compared to those with an MSI less than 0.7 (p=0.001). The
study revealed a significant association between MSI and mortality; an MSI >1 was associated
with 11.814 times increased mortality odds compared to an MSI <0.7 (p=0.001). RDW >14.5%
was associated with .167 times higher odds of mortality than RDW <14.5% (p=0.001, OR=
.167). The Modified SOFA is also associated with mortality, with higher scores >11 indicating
an elevated risk of mortality (Exp(B) = 3.977, 95% CI [1.643, 9.626]. Combining MSI and RDW
improved mortality prediction in septic patients (Exp(B) = .405, 95% CI [.215, .761]).
Conclusion: Our analysis identifies gender, modified SOFA score, MSI, and RDW as critical
determinants of sepsis-related mortality. The combined consideration of MSI and RDW
enhances mortality prediction in sepsis cases, contributing to a nuanced understanding of sepsis
management.
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Keywords
Sepsis, Modified Shock Index, Red Cell Distribution Width