Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 23;12(9):e062245.
doi: 10.1136/bmjopen-2022-062245.

Enhanced red blood cell distribution width to platelet ratio is a predictor of mortality in patients with sepsis: a propensity score matching analysis based on the MIMIC-IV database

Yuanjun Zhou  1 , Liping Zhong  1 , Weiming Chen  1 , Fei Liang  1 , Yilin Liao  1 , Yuting Zhong  2
Affiliations

Enhanced red blood cell distribution width to platelet ratio is a predictor of mortality in patients with sepsis: a propensity score matching analysis based on the MIMIC-IV database

Yuanjun Zhou et al. BMJ Open. .

Abstract

Objective: To explore the association between dynamic changes in red blood cell distribution width to platelet count ratio (RPR) during hospitalisation and short-term mortality in patients with sepsis.

Design: A retrospective cohort study using propensity score matching.

Setting: Intensive care units (ICUs) of Beth Israel Deaconess Medical Center.

Participants: A total of 8731 adult patients with sepsis were included in the study. The patients were identified from the ICU of the Medical Information Mart for Intensive Care database. The observed group included patients who experienced an increase in RPR of more than 30% during the first week of ICU admission, whereas the control group included the rest.

Main outcome and measure: Using propensity score matching, a matched control group was created. The primary outcome was 28-day mortality, and the length of hospital stay and in-hospital mortality were the secondary outcomes.

Results: The difference was evident in 28-day mortality between the two groups (85.8% vs 74.5%, p<0.001, Kaplan-Meier analysis, and HR=1.896, 95% CI=1.659 to 2.168, p<0.001, Cox regression). In the secondary outcomes, there was a significant difference in in-hospital mortality (p<0.001). In addition, the study discovered that the observed groups had a significantly longer hospital stay (p<0.001). Meanwhile, the results of subgroup analyses were consistent with those of the primary analyses.

Conclusions: In patients with sepsis, a significantly increased RPR is positively associated with the short-term death rate. Continuous RPR monitoring could be a valuable measure for predicting short-term mortality in patients with sepsis.

Keywords: Adult intensive & critical care; INTENSIVE & CRITICAL CARE.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ROC for the change in RPR. Change in RPR: AUC=0.680, p<0.001, 95% CI 0.663 to 0.696, sensitivity value 49% and specificity value 78%; baseline RPR: AUC=0.588, p<0.001, 95% CI 0.570 to 0.606, sensitivity value 44% and specificity value 70%. AUC, area under the curve; ROC, receiver operating characteristics; RPR, red cell distribution width to platelet ratio.
Figure 2
Figure 2
Flow chart for the process of inclusion steps and exclusion steps. RPR, red cell distribution width to platelet ratio.
Figure 3
Figure 3
Kaplan-Meier curves for 28-day survival. The 28-day mortality of the patients with an elevated levels of RPR ≥30% compared with the others. RPR, red blood cell distribution width to platelet count ratio.
Figure 4
Figure 4
Subgroup analysis comparing the hazard of 28-day mortality in subgroups of patients with sepsis with an increased RPR greater than 30% and other patients with an increased RPR lower than 30%. Independent propensity score matching was performed for each subgroup. The flow chart of the subgroup analysis was provided in the online supplemental material 2. RPR, red blood cell distribution width to platelet count ratio; SOFA, Sequential Organ Failure Assessment.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Shankar-Hari M, Phillips GS, Levy ML, et al. . Developing a new definition and assessing new clinical criteria for septic shock: for the third International consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:775–87. 10.1001/jama.2016.0289 - DOI - PMC - PubMed
    1. Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care--reasons for caution. N Engl J Med 2014;370:1673–6. 10.1056/NEJMp1400276 - DOI - PMC - PubMed
    1. Stearns-Kurosawa DJ, Osuchowski MF, Valentine C, et al. . The pathogenesis of sepsis. Annu Rev Pathol 2011;6:19–48. 10.1146/annurev-pathol-011110-130327 - DOI - PMC - PubMed
    1. Delano MJ, Ward PA. Sepsis-induced immune dysfunction: can immune therapies reduce mortality? J Clin Invest 2016;126:23–31. 10.1172/JCI82224 - DOI - PMC - PubMed
    1. Pierrakos C, Vincent J-L. Sepsis biomarkers: a review. Crit Care 2010;14:R15. 10.1186/cc8872 - DOI - PMC - PubMed