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. 2025 Jul 29;25(1):539.
doi: 10.1186/s12876-025-04167-5.

Association of red blood cell distribution width with short- and long-term all-cause mortality in patients with acute pancreatitis and sepsis

Qingzhou Song #  1 , Xuanlin Wu #  2 , Firooz Ahmad Taheri  1 , Linghou Meng  1 , Wentao Wang  1 , Xianwei Mo  3
Affiliations

Association of red blood cell distribution width with short- and long-term all-cause mortality in patients with acute pancreatitis and sepsis

Qingzhou Song et al. BMC Gastroenterol. .

Abstract

Background: The association between red blood cell distribution width (RDW) and short- and long-term all-cause mortality in patients with acute pancreatitis (AP) and sepsis remains unclear.

Methods: Data were extracted from the MIMIC-IV database for patients diagnosed with AP and sepsis. The primary research endpoints were all-cause mortality at 28, 90, and 365 days. Kaplan-Meier survival curve analysis, restricted cubic spline (RCS) receiver operating characteristic (ROC) curves, subgroup analysis, and Cox regression were employed to assess the association between RDW and mortality.

Results: A total of 759 patients with AP and sepsis were included. The all-cause mortality rates were 17.26%, 25.96%, and 31.49% at 28, 90, and 365 days, respectively. Cox regression analysis indicated that, after adjustment for covariates, elevated RDW was significantly associated with increased risk of mortality at 28, 90, and 365 days. The hazard ratios (HR) were 1.08 (95% CI: 1.02-1.14) for 28-day mortality, 1.12 (95% CI: 1.07-1.17) for 90-day mortality, and 1.13 (95% CI: 1.08-1.18) for 365-day mortality. The RCS analysis indicated a nonlinear relationship. Kaplan-Meier analysis demonstrated significantly higher mortality in the high-RDW group compared to the low-RDW group (p < 0.001). The area under the curve (AUC) for RDW was greater than that for BISAP and SIRS, but lower than the SOFA. Subgroup analyses showed no significant interactions between RDW and most subgroups.

Conclusion: Elevated RDW is independently associated with increased short- and long-term all-cause mortality in patients with AP and sepsis.

Keywords: Acute pancreatitis; All-cause mortality; MIMIC-IV.; Red blood cell distribution width; Sepsis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with Good Clinical Practice (Declaration of Helsinki 2002). The data was extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV, Version 3.1). All personal information has been removed, and the identity of the patient has been replaced by a random number. Thus, there were no additional consent procedures from the institutional ethics committee. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of patients’ selection
Fig. 2
Fig. 2
Kaplan-Meier survival curves for all-cause mortality at 28 days (A), 90 days (B), and 365 days (C) in different RDW groups
Fig. 3
Fig. 3
RCS curve of the relationship between RDW and all-cause mortality (A) 28 days; (B) 90 days; (C) 365 days
Fig. 4
Fig. 4
ROC curve analysis of RDW, BISAP, SIRS, and SOFA in predicting all-cause mortality at 28 days (A), 90 days (B), and 365 days (C). RDW: red blood cell distribution width; BISAP: beside index for severity in acute pancreatitis; SIRS: systemic inflammatory response syndrome; SOFA: sequential organ failure assessment
Fig. 5
Fig. 5
Forest plots of subgroup analysis of the relationship between RDW and all-cause mortality in patients with acute pancreatitis and sepsis (A) 28 days; (B) 90 days; (C) 365 days
See this image and copyright information in PMC

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