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. 2023 Sep 20:18:2079-2091.
doi: 10.2147/COPD.S418162. eCollection 2023.

A Prediction Model for In-Hospital Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease Patients Based on Red Cell Distribution Width-to-Platelet Ratio

Shi Chen  1 , Yi Shi  1 , Bingzhu Hu  1 , Jie Huang  2
Affiliations

A Prediction Model for In-Hospital Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease Patients Based on Red Cell Distribution Width-to-Platelet Ratio

Shi Chen et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: To explore the association between red cell distribution width (RDW)-to-platelet ratio (RPR) and in-hospital mortality of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients and establish a prediction model based on RPR and other predictors.

Material and methods: This cohort study included 1922 AECOPD patients aged ≥18 years in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV as well as 1738 AECOPD patients from eICU Collaborative Research Database (eICU-CRD). Possible confounding factors were screened out by univariate logistic regression, and multivariable logistic regression was applied to evaluate the association between RPR and in-hospital mortality of AECOPD patients. The area under the curve (AUC), calibration curve and decision curve analysis (DCA) curve were plotted to evaluate the predictive value of the model. The median follow-up time was 3.14 (1.87, 6.25) day.

Results: At the end of follow-up, there were 1660 patients survived and 262 subjects died. After adjusting for confounders, we found that Log (RPR×1000) was linked with elevated risk of in-hospital mortality of AECOPD patients [odds ratio (OR)=1.36, 95% confidence interval (CI): 1.01-1.84]. The prediction model was constructed using predictors including Log (RPR×1000), age, malignant cancer, atrial fibrillation, ventilation, renal failure, diastolic blood pressure (DBP), temperature, Glasgow Coma Scale (GCS) score, white blood cell (WBC), creatinine, blood urea nitrogen (BUN), hemoglobin, infectious diseases and anion gap. The AUC of the prediction model was 0.785 (95% CI: 0.751-0.820) in the training set, 0.721 (95% CI: 0.662-0.780) in the testing set, and 0.795 (95% CI: 0.762-0.827) in the validation set.

Conclusion: RPR was associated with the in-hospital mortality of AECOPD patients. The prediction model for the in-hospital mortality of AECOPD patients based on RPR and other predictors presented good predictive performance, which might help the clinicians to quickly identify AECOPD patients at high risk of in-hospital mortality.

Keywords: acute exacerbations of chronic obstructive pulmonary disease; platelet ratio; red cell distribution width; red cell distribution width-to-platelet ratio.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The screen process of the participants in our study.
Figure 2
Figure 2
The ROC curves of our prediction model, SOFA score, and CURB-65 in the training set.
Figure 3
Figure 3
The ROC curves of our prediction model, SOFA score, and CURB-65 in the testing set.
Figure 4
Figure 4
The ROC curves of our prediction model, SOFA score, and CURB-65 in the validation set.
Figure 5
Figure 5
The calibration curves of the prediction model in the training set.
Figure 6
Figure 6
The calibration curves of the prediction model in the testing set.
Figure 7
Figure 7
The calibration curves of the prediction model in the validation set.
Figure 8
Figure 8
The nomogram of the prediction model.
Figure 9
Figure 9
The DCA curve of our prediction model, SOFA score, and CURB-65.
See this image and copyright information in PMC

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