Application Of Red Blood Cell Distribution Width And Its Derivatives In The Prognosis And Treatment Of Sepsis

Background: Sepsis is a common life-threatening syndrome,with 31 million cases and up to 6 million deaths worldwide annually,contributing to a major source of global morbidity and mortality.Excessive inflammatory response and immunosuppression are the leading causes of death in people with sepsis.Biomarkers are a class of measure indicators that describe the clinical status of patients.They can accurately reflect the body status through repeated detection and can be used for diagnosis,early identification,risk stratification,treatment guidance and prognostic assessment of patients with sepsis or suspected sepsis.However,in addition to currently existing inflammatory markers and critical illness scores to assist the judgment,there is still a lack of biomarkers with high sensitivity and specificity to further assess the progression of a sepsis patient’s disease.To find more concise and accurate biomarkers for timely and adequate diagnosis of sepsis and prognostic judgement,and to improve adverse outcomes of the patients are urgent problems for clinicians to solve.In the first section,we analyzed the early clinical characteristics and prognostic risk factors of sepsis.Objectives: Sepsis-related database was constructed to compare the clinical characteristics between the survival group and death group to find the risk factors for early death and to explore its value in predicting the sepsis prognosis and provide evidence for predicting sepsis prognosis and individualized treatment.Methods: Basic information and clinical data of sepsis patients admitted to the emergency Department of Xijing Hospital from May 1,2019 to April 30,2022 were collected,and subjects were enrolled according to the inclusion and exclusion criteria.General data(gender,age,hospital stay,body temperature,heart rate,respiratory rate,systolic blood pressure,diastolic blood pressure and the presence of underlying diseases,etc.)and clinical data(routine blood tests,cardiac,hepatic,pulmonary,and renal function tests,etc.)were collected,and critical illness scores and ratios were calculated.Patients were divided into survival and death groups according to the 28-day prognosis,and the difference between the two groups was compared.Risk factors with statistically significant differences for short-term prognosis of sepsis(28-day mortality)were further analyzed.Receiver operating characteristic(ROC)was plotted to compare the prognostic ability of single and combined indicators.Kaplan-Meier(K-M)survival curve predicted28-day survival.Results:(1)A total of 114 patients were divided into survival group(90 patients)and death group(24 patients)according to their prognosis,and univariate analysis of relevant indicators suggested that the differences of neurophils,lymphocytes,systolic blood pressure,diastolic blood pressure,prothrombin time,international normalized ratio,Sequential Organ Failure Assessment(SOFA),National Early Warning Score(NEWS),partial pressure of oxygen,oxygen concentration fraction,oxygenation index,and blood lactate between the two groups were statistically significant.Red blood cell distribution width(RDW)and red blood cell distribution width to Lymphocyte ratio(RLR)in death group were significantly higher than those in the surviving group.(2)Cox regression analysis and prognostic correlation heatmap showed that Systolic Blood Pressure(SBP),RDW,and RLR were independent factors affecting the patient’s survival.(3)K-M survival curves showed that RDW and RLR were significantly correlated with the patient’s survival.(4)ROC curve analysis of RDW and RLR suggested excellent predictive efficacy of both,with RLR slightly better than RDW.Conclusion: RDW and RLR are independent risk factors affecting the short-term prognosis of sepsis and can be used to clinically determine the risk of early death in sepsis.In the second section,we analyzed the early warning indicators of sepsis-associated liver injury.Objectives: To identify the early risk factors for the occurrence of sepsis-related liver injury and to provide reference for early identification of sepsis-related liver injury and proper diagnosis and treatment.Methods: The clinical information of patients with sepsis admitted to the emergency department of Xijing Hospital from January 1,2019 to October 30,2022 was collected,and the general condition,biochemical indexes,critical disease scores,ratio indexes and follow-up results of patients were recorded.According to the follow-up results,the patients were divided into liver injury group and non-liver injury group.K-M survival curve was used to compare the effects of sepsis combined with liver injury on the survival rate between the two groups.Early warning factors of patients with sepsis complicated with liver injury were determined by Logisitic regression analysis.ROC curve was plotted to assess the judgmental validity of warning indicators and restricted cubic spline plot was used for further validation.The decision curve and clinical impact curve were used to evaluate the clinical effects of the predictors.Results:(1)The 179 patients with sepsis who met the inclusion criteria were divided into non-liver injury group(99 cases)and liver injury group(80 cases).Survival analyses of both groups showed a significant reduction in 28-day survival in the sepsis group with liver injury compared to the non-liver injury group(p=0.012).(2)The incidence of combined hypertension in sepsis was 41 cases in the liver injury group,which was significantly higher than that in the non-liver injury group(p=0.04).(3)Comparison of the routine blood indices,chemistry parameters,and critical illness scores of the patients in the two groups showed that the hemoglobin to red blood cell distribution width ratio(HB/RDW),hemoglobin(HB),albumin(ALB),and platelet count(PLT)were significantly lower in the liver injury group than those in the non-liver injury group(p<0.05).Red blood cell distribution width to albumin ratio(RAR),RDW,and red blood cell distribution width to platelet count ratio(RPR),aspartate transaminase to platelet ratio(AST/PLT),RLR,and procalcitonin(PCT)values were significantly higher in the liver injury group than those in the non-liver injury group(p<0.05).(4)Multi-factor logistic regression analysis showed that HB/RDW and ALB were independent risk factors for sepsis-associated liver injury.(5)ROC curve and the area under ROC curve(AUC)showed that HB/RDW has good efficacy in evaluating sepsis complicated with liver injury.(6)Restricted cubic spline plot showed that the probability of occurrence of liver injury increased as the value of HB/RDW decreased(HB/RDW<2.33),while the probability of occurrence of liver injury did not change significantly as the value of HB/RDW increased(HB/RDW≥2.33).(7)The CIC results indicate that the threshold rate exceeds 0.6 and predicts the occurrence of septic liver injury with high agreement with actual occurrence.HB/RDW has promising clinical applications.Conclusion: HB/RDW within 24 hours of admission is a good predictor of liver injury in sepsis patients and can be used as an early warning indicator to help clinicians identify it quickly.