Platelet Count and Platelet Indices (Mean Platelet Volume, Platelet Distribution Width) and Red Cell Distribution Width and Their Significance in Severe Sepsis: A Hospital-Based Observational Study

Hoysalakumar D P; Pradeep G S; Satheesha B C; Sharath Kumar V T

doi:10.37022/wjcmpr.v8i2.417

Authors

Hoysalakumar D.P Assistant Professor Department of General Medicine S.S. Institute of Medical Sciences and Research Centre Davangere, Karnataka, India
Pradeep G.S. Assistant Professor Department of General Medicine S.S. Institute of Medical Sciences and Research Centre Davangere, Karnataka, India
Satheesha B.C. Associate Professor, Subbiah Institute of Medical Sciences.
Sharath Kumar V.T Postgraduate Department of General Medicine S.S. Institute of Medical Sciences and Research Centre Davangere, Karnataka, India

Abstract

Background: Sepsis remains a leading cause of morbidity and mortality in intensive care settings worldwide. Early risk stratification is central to improving outcomes, but conventional biomarkers such as C-reactive protein (CRP) are limited by cost and delayed availability in resource-constrained settings. Platelet indices and red cell distribution width (RDW), both derived from a routine complete blood count, may serve as inexpensive surrogates of inflammation, coagulopathy and bone-marrow stress.

Aim: To evaluate the association of platelet count, platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], plateletcrit [PCT]) and RDW with disease severity (SOFA, qSOFA, APACHE II scores) and clinical outcome in patients with severe sepsis.

Materials and Methods: This hospital-based observational study enrolled 90 adults with severe sepsis at a tertiary-care teaching hospital over two years. Platelet count, MPV, PDW, PCT, RDW and CRP were recorded at admission and serially at 24 and 72 hours, and correlated with SOFA, qSOFA and APACHE II scores and with clinical outcome (improvement, worsening or death). A p-value <0.05 was considered statistically significant.

Results: Thrombocytopenia was present in 60.0% of patients at admission and was associated with poorer outcome. MPV and PDW correlated positively with SOFA, qSOFA and APACHE II scores (r = 0.34-0.51, p < 0.01) and with CRP (p < 0.05), while platelet count correlated negatively with CRP (p < 0.05). Patients with elevated MPV/PDW had a markedly lower rate of clinical improvement (68.8%) and a higher rate of death (14.5%) than those with normal indices (95.2% and 2.4%, respectively). RDW was elevated (>14.5%) in 57.8% of patients and was associated with a longer ICU stay and greater ventilator requirement, with a significant decline over 72 hours in patients who improved (p < 0.05).

Conclusion: Platelet count, platelet indices and RDW - all obtainable from a single, inexpensive complete blood count - correlate closely with validated severity scores and clinical outcome in severe sepsis. Their combined interpretation, alongside CRP, offers a practical, low-cost tool for early risk stratification, particularly in resource-limited settings.

Keywords:

Sepsis, Platelet indices, Mean platelet volume, Platelet distribution width, Red cell distribution width, C-reactive protein, SOFA score, APACHE II

DOI

https://doi.org/10.37022/wjcmpr.v8i2.417

References

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.

2. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774.

3. Ventetuolo CE, Levy MM. Sepsis: a clinical update. Clin J Am Soc Nephrol. 2008;3(2):571-577.

4. Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis - the role of laboratory medicine. Clin Chim Acta. 2016;460:203-210.

5. Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, et al. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect. 2005;11:101-108.

6. Golebiewska EM, Poole AW. Platelet secretion: from haemostasis to wound healing and beyond. Blood Rev. 2015;29:153-162.

7. Margetic S. Inflammation and haemostasis. Biochem Med (Zagreb). 2012;22:49-62.

8. Venkata C, Kashyap R, Farmer JC, Afessa B. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 2013;1(1):9.

9. Vardon-Bounes F, Ruiz S, Gratacap MP, Garcia C, Payrastre B, Minville V. Platelets are critical key players in sepsis. Int J Mol Sci. 2019;20(14):3494.

10. Guclu E, Durmaz Y, Karabay O. Effect of severe sepsis on platelet count and their indices. Afr Health Sci. 2013;13(2):333-338.

11. Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LMC, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care. 2014;4(1):20.

12. Torres VM, Royuela A, Rubio EM, et al. Red blood cell distribution width as a prognostic factor in sepsis. J Crit Care. 2022;71:154069.

13. Krishna V, et al. Red cell distribution width as a mortality predictor in patients with sepsis: a prospective observational study. Indian J Med Res. 2020;151(3):285-291.

14. Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37(5):1649-1654.

15. Gupta A, Kumar S, Acharya S, Sarode R, Agrawal S, Gemnani R, et al. Utility of platelet indices as prognostic markers of sepsis: a medical intensive care unit-based cross-sectional study at a rural setup. Cureus. 2024;16(2):e54490.

16. Zhang Z, Xu X, Ni H. Mean platelet volume to platelet count ratio as a prognostic marker in patients with sepsis. PLoS One. 2022;17(2):e0262356.

17. Sayed SZ, Mahmoud MM, Moness HM, Mousa SO. Admission platelet count and indices as predictors of outcome in children with severe sepsis: a prospective hospital-based study. BMC Pediatr. 2020;20:387.

18. Samuel D, Bhat AN, Joseph J, et al. Platelet indices as predictive markers of prognosis in critically ill patients: a prospective study. Indian J Crit Care Med. 2020;24(9):817-822.

19. Sharma DJ, Ganguly S, Rakesh M, et al. Utility of platelet indices as a predictive marker in sepsis: an observational study. Cureus. 2023;15(4):e38095.

20. Taha RS, Afandy ME, Elbadawi AH, Abd El Ghafar MS. Platelet indices in critically ill septic patients as a predictor of mortality. Egypt J Anaesth. 2023;39(1):56-62.

21. Tajarernmuang P, Phrommintikul A, Limsukon A, Pothirat C, Chittawatanarat K. The role of mean platelet volume as a predictor of mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Res Pract. 2016;2016:4370834.

22. Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS, et al. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. PLoS One. 2015;10(3):e0119437.

23. Mangalesh S, Dudani S, Malik A. Platelet indices and their kinetics predict mortality in patients of sepsis. Indian J Hematol Blood Transfus. 2021;37(4):600-608.

24. Acikgoz S, Akduman D, Eskici ZM, et al. Thrombocyte and erythrocyte indices in sepsis and disseminated intravascular coagulation. J Med Biochem. 2012;31:60-64.

25. Dubey A, Kumar S, Acharya S, Wanjari AK, Bawankule S, Agrawal S, et al. Impact of red cell and platelet distribution width in patients of medical intensive care unit. J Lab Physicians. 2021;13(4):309-316.

26. Maricar MH, Kathiravan AR, Balamurugan AR, Radhakrishnan V. Study of effect of sepsis on platelet count and their indices - mean platelet volume and platelet distribution width and their prognostic significance and correlation with C-reactive protein. Int J Acad Med Pharm. 2023;5(6):989-993.

27. Kumar S, Patel R, Shah P. Platelet indices as predictive markers for sepsis and septic shock. Glob J Med Clin Case Rep. 2022;12:294.

28. Saharia HK, Das O, Vignesh S. Correlation of platelet indices with severity of sepsis patients in ICU: a prospective observational study. Int J Curr Pharm Rev Res. 2025;17(3):133-140.

29. Yadav S, Chaitany BSB, Meena LP, Kumar S, Gupta S, Rai A. Study to evaluate the role of platelet count and platelet indices as predictors of outcome in patients with sepsis at a tertiary care hospital. J Contemp Clin Pract. 2025;11(2):637-643.

30. Gao Y, Li Y, Yu X, Guo S, Ji X, Sun T, et al. The impact of various platelet indices as prognostic markers of septic shock. PLoS One. 2014;9(8):e103761.