Związek między wskaźnikiem rozkładu objętości erytrocytów a hematokrytem a 28-dniową umieralnością ogólną u pacjentów z sepsą

OBJECTIVES: To investigate the association between the red blood cell distribution width to hematocrit (RDW/HCT) ratio and 28-day all-cause mortality in patients with sepsis. METHODS: A retrospective cohort study was conducted using the MIMIC-IV database (27 335 adult patients), and the eICU-CRD database was used for external validation (17 406 adult patients). The patients were grouped by RDW/HCT ratio quartiles. The primary outcome was 28-day all-cause mortality. Kaplan-Meier survival curves were used to assess the survival rates. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed to examine the association between RDW/HCT ratio and patient mortality. Subgroup analyses were conducted to assess the robustness of the findings. RESULTS: The 28-day mortality rates were 19.3% in the MIMIC-IV cohort and 16.0% in the eICU-CRD cohort. In the MIMIC-IV cohort, Kaplan-Meier analysis showed that a higher RDW/HCT ratio was associated with an increased risk of 28-day mortality in septic patients (log-rank P<0.0001). Multivariable Cox regression analysis suggested that an elevated RDW/HCT ratio was an independent risk factor for 28-day mortality in septic patients (HR=1.89, 95% CI: 1.52-2.36, P<0.001). RCS analysis showed a non-linear, U-shaped relationship between the RDW/HCT ratio and 28-day mortality of septic patients. No significant interactions were observed in subgroup analyses. The trends in the eICU-CRD validation cohort were consistent with those observed in the MIMIC-IV cohort. Conclusion Elevation of the RDW/HCT ratio is associated with an increased 28-day all-cause mortality rate in patients with sepsis.