الفهرس 
SEPSISOnly 14 pages are availabe for public view
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Abstract
Sepsis remains a major challenge in clinical practice with considerable morbidity and mortality despite modern treatments. Clinicians need good diagnostic and prognostic markers to identify infected patients who would rapidly benefit from prompt, empirical antibiotic therapy and other supportive treatment.
Our study is prospective one in which patients with sepsis and septic shock were treated in ICU with recent ICU guidelines (surviving sepsis campaign), it aimed to assess the diagnostic and prognostic Value of RDW, PCT in patients with sepsis and septic shock.
Our study demonstrated that RDW increased in patients presented with sepsis and septic shock so it can be used as diagnostic index in severe infections and sepsis, as well as it can be used a prognostic marker of all-cause mortality in patients as higher RDW was detected in non survivors than survivors 18.67 ± 0.87 vs 15.00 ± 0.76..
It is found that a change and increase in RDW value during daily monitoring at day 0, 3, 6, 9 and 12 had a significant impact on prognosis of sepsis so it is considered that RDW can be a prognostic marker in septic patients and that a rise in RDW could serve as an early indicator of adverse outcomes including mortality as in day 12 RDW mean was 15.00 ± 0.80 in patients with sepsis and 17.21 ± 1.96 in patients with septic shock.
According to cutoff point for RDW, it was found > 15.6 with sensitivity of 80.0%, specificity of 85.71% and AUC of 84.3% in baseline value while for day 12 which was found > 17.3 with sensitivity of 60.0%, specificity of 100.0%.
According to PCT, our study reported that PCT is a valuable biomarker for the early detection of sepsis in suspected patients and prognosis of sepsiss as it was detected to be high at admission, higher level was associated with increased severity of sepsis at day 0, 3, 6, 9 and 12 and lower level associated with good management and good prognosis.
PCT level can predict mortality as Non-survivors has higher PCT level than survivors, PCT show different cut off values, it was found > 4.1 with sensitivity of 80.0% and specificity of 94.29% in baseline values while for day 6 level cutoff point was found > 2.9 with sensitivity of 93.33%, specificity of 85.71% the cutoff point for PCT in day 12 which was found > 0.7 with sensitivity of 80.0%, specificity of 97.0%.
LIMITATION
RDW varies in many conditions as anemia, pulmonary hypertension, tumors, acute kidney injury, heart failure and acute myocardial infarction, the underling mechanism responsible for the correlation between elevated RDW and mortality remains unclear and a matter of continued research.
Patients presented with sepsis and had renal impairment may had PCT values higher than assumed as the reduced glomerular filtration rate may affect PCT clearance.
The sample size and percentage of mortality of the studied population on our study may have a role. Further studies with larger samples are needed to confirm these findings.
RECOMMENDATIONS
1- Higher RDW was associated with increased severity of sepsis which means it can help in diagnosis and prognosis of sepsis by follow up values that show higher RDW in non-survivors than survivors, since RDW determination is inexpensive, it could be used routinely as a biomarker of early mortality in septic patients.
2- PCT is elevated in sepsis and higher in non survivors than survivors so it can be used as a parameter to assist in diagnosis of critically sick people presented with sepsis and progression of these cases and follow up response to medical treatment through daily monitoring.
3- Another study on large number of patients should be done to avoid the limitation of this study.