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Multicenter Study
. 2025 Aug 13;20(8):e0328980.
doi: 10.1371/journal.pone.0328980. eCollection 2025.

Association between mean corpuscular volume and mortality in chronic kidney disease ICU patients: A retrospective multicenter cohort study

Sheng Chen  1 , Yiwen Li  1 , Lin Guo  1 , Xiaohan Ma  1 , Xuejin Ye  1 , Lingling Wu  2 , Ting Zhang  2 , Hongjun Gao  2
Affiliations
Multicenter Study

Association between mean corpuscular volume and mortality in chronic kidney disease ICU patients: A retrospective multicenter cohort study

Sheng Chen et al. PLoS One. .

Abstract

Background: Chronic kidney disease (CKD) affects over 10% of the global population and is closely linked to increased cardiovascular morbidity and mortality. Mean corpuscular volume (MCV), a key hematological parameter, has been associated with various clinical outcomes. However, the relationship between MCV and mortality in CKD patients admitted to the intensive care unit (ICU) has not been thoroughly investigated, with previous studies primarily limited to single-center designs.

Methods: This retrospective multicenter cohort study analyzed data from the eICU-CRD and MIMIC-IV databases. Statistical analyses involved Kaplan-Meier survival curves and multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were employed to assess the potential nonlinear relationships between MCV and mortality.

Results: A total of 23,724 patients were included in the analysis. Higher MCV levels were significantly associated with increased 30-day and 90-day in-hospital mortality. Kaplan-Meier analysis revealed a higher mortality risk in patients with the highest MCV levels. Cox models confirmed that MCV was a significant risk factor for mortality, with hazard ratios indicating an increased risk with each unit increase in MCV. Subgroup analyses consistently showed that elevated MCV levels were associated with a higher mortality risk across different patient groups.

Conclusion: This first multicenter study demonstrated that elevated MCV levels are significantly associated with higher short-term mortality in CKD ICU patients, suggesting that MCV could serve as a potential biomarker for risk stratification. Future research should validate these findings and explore the underlying mechanisms.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the study population.
Fig 2
Fig 2. Kaplan-Meier curves showing the cumulative probability of mortality.
(A) Death within 30 days in the original cohort; (B) death within 90 days in the original cohort; (C) death within 30 days in the validation cohort; and (D) death within 90 days in the validation cohort.
Fig 3
Fig 3. RCS for all-cause mortality.
(A) 30-day mortality in the original cohort; (B) 90-day mortality in the original cohort; (C) 30-day mortality in the validation cohort; and (D) 90-day mortality in the validation cohort.
See this image and copyright information in PMC

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