| Objective:1.Objective to investigate the prognostic value of red blood cell distribution width-to-platelet count(RPR)in adult patients with sepsis in intensive care unit(ICU).2.To investigate the predictive value of sequential organ failure assessment(SOFA)score and RPR combined model in predicting the 28-day outcome of adult patients with sepsis in ICU.Methods:A retrospective analysis was performed on 177 adult patients with sepsis treated in the Department of Critical Care Medicine of the First Affiliated Hospital of Henan University from January2018 to October 2022,and they were divided into survivor group and non-survivor group according to the prognosis of 28 days.Data collection:(1)General data of patients,such as sex,age,infection site and complications,were recorded.(2)Basic clinical parameters such as C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB),SOFA score and acute physiology and chronic health evaluation scoring system II(APACHE II)were collected retrospectively within 24 hours after admission to ICU.(3)Red blood cell distribution width(RDW)and platelet count(PLT)were recorded on the 1st,3rd and 5th day after admission to ICU.(4)Definition of short-term dynamic change of RPR:Short-term RPR elevation group:(1)RPR elevation:3-d or 5-d RPR>1-d RPR;(2)RPR increased continuously: RPR increased continuously on the 1st,3rd and 5th day;RPR significantly increased in short term group:(1)RPR significantly increased:≥20% increase in 3-day or 5-day RPR compared to 1-day RPR;(2)RPR increased continuously and significantly: RPR increased continuously at 1,3 and 5 days,and the increase rate was ≥20%.Study Methods: Student ’s t-test or Mann-Whitney U test was used to statistically analyze the between-group differences in clinical parameters.Receiver operating characteristic(ROC)curves were used to assess the predictive power of each clinical parameter for 28-day outcome in adult patients with sepsis in ICU,and to determine the optimal cut-off value,area under the ROC curve(AUC),sensitivity,and specificity of each parameter.Cox proportional hazards models and logistic regression models were constructed to analyze the association between short-term dynamics of RPR and 28-day mortality in adult patients with sepsis in ICU,both adjusted for potential confounders using two models.Logistic regression models were used to determine the predictive value of RPR and SOFA scores for 28-day mortality in adult patients with sepsis in ICU,and to adjust for potential confounding factors.Results:1.Of the 177 adult patients with sepsis collected,there were 104 in the survivor group and 73 in the non-survivor group,with an overall mortality rate of approximately 41.2%.Analysis of differences between groups showed that:(1)The patients in non-survivor group were more likely to have complications such as immune system diseases and septic shock,and the difference was significant(P<0.05).(2)The age,APACHE Ⅱ,SOFA score,PCT and CRP in non-survivor group were 71(61,77),23.32±5.45,7.65±1.85,25.94±23.39 and 143.48±82.06 respectively,which were significantly higher than those in survivors group [66(51,77),16.87±4.94,5.26±1.63,6.49±12.18 and 102.23±82.83respectively].The ALB of non-survivor group(27.64±4.00)was lower than that of survivor group(30.58±4.41),the difference was significant(P<0.05).(3)The RDWs of non-survivor group were 14.96±1.73,14.95 ±1.70 and 15.03±1.75 on day 1,3 and 5,respectively,which were higher than those of survivor group(13.34± 1.07,13.42 ±1.16 and 13.39±1.10,respectively,P<0.05).On the contrary,the PLTs in the non-survivor group were 137.76±70.64,93.27±50.48 and 83.90±47.20 on day 1,3 and 5,respectively,which were generally lower than those in the survivor group(221.81±104.24,201.91±94.84 and190.20±86.90,respectively,P<0.05).(4)RPR is the ratio of RDW to PLT,and its results of intergroup differences are in accordance with the results of RDW and PLT: The RPRs in non-survivor group were1.57± 1.26,2.27 ±1.62 and 2.54±1.74 on day 1,3 and 5,respectively,which were significantly higher than those in survivor group(0.82± 0.68,0.92 ±0.79 and 0.92±0.68,respectively,P<0.05).The RPRs of non-survivor group increased significantly with the treatment days.(5)RPR increased and the proportion of significantly increased in non-survivors group was significantly higher than that in survivors group(P<0.05).The proportion of patients with elevated 3-d RPR was the highest in the non-survivors group(60cases,82.2%),and the rate of RPR continuously increased was the lowest,27 cases(37.0%).2.As shown by ROC curves of clinical parameters,the AUCs of 1-,3-,and 5-day RPR were0.788(95% CI 0.723-0.852)<0.871(95% CI 0.818-0.924)<0.881(95% CI 0.832-0.929),respectively,and the clinical predictive value of RPR increased with increasing days of treatment.The 5-day RPR had the best diagnostic power in predicting 28-day mortality in adult patients with sepsis.The cut-off value,sensitivity and specificity were >2.59,94.52% and 72.12%,respectively.And the SOFA score had the best diagnostic power among clinical parameters on the first day of ICU,with an AUC of 0.834(95% CI 0.774-0.894).3.Cox proportional hazards model and Logistic regression model:(1)Unadjusted model:Short-term dynamic changes in RPR were all associated with an increased risk of 28-day mortality in adult patients with sepsis in ICU.The OR and HR values of the group with short-term significantly increased RPR were higher than those of the corresponding group with short-term increased RPR.The OR and HR of the group with significantly increased RPR were the highest,9.587(3.702-24.825)and 3.603(2.231-5.816)respectively.(2)After adjusting for confounding factors in model I,the short-term dynamic changes of RPR were still associated with an increased risk of 28-day death in adult patients with sepsis in ICU.However,HR was decreased in the groups of sustained and 3-d RPR increase,while the other OR and HR were increased.The OR and HR values of the 5-day RPR significantly increased group were the highest,19.085(5.285-68.914)and 3.820(2.168-6.731),respectively,which were better than those of the RPR continuously increased group before adjustment.(3)After adjusting for confounding factors in model II,the short-term dynamic changes of RPR were still associated with an increased risk of 28-day death in adult patients with sepsis in ICU.However,HR was decreased in the groups of sustained and 3-d RPR increase,while the other OR and HR were increased.The OR and HR values of the 5-day RPR significantly increased group were the highest,19.085(5.285-68.914)and 3.820(2.168-6.731),respectively,which were better than those of the RPR continuously increased group before adjustment.4.Logistic regression analysis:SOFA score,APACHE II score,and 1-,3-,and 5-day RPR were all risk factors for 28-day mortality in adult patients with sepsis in ICU.Among them,1,3,and 5-day RPR and SOFA scores had higher OR values than other clinical parameters.After adjustment for confounders: In groups A,B,and C,RPR and SOFA scores were independent predictors of 28-day mortality in adult patients with sepsis in ICU.The OR value of RPR increased with the increase of treatment days,which was significantly better than the predictive power of other clinical parameters on the first day.5.Combined model: The AUC values of the 1-,3-,and 5-d RPR-SOFA combined models were0.856(95% CI 0.804-0.913),0.888(95% CI 0.841-0.935),and 0.915(95% CI 0.875-0.955),respectively,which were significantly better than their respective predictive powers.Among them,the AUC value of 5-d RPR-SOFA was the highest,and the sensitivity was 94.52% and the specificity was 72.12% when the best cut-off value was>2.59.The sensitivity was higher than that of 5-d RPR and SOFA,but the specificity was lower.Conclusion:1.Short-term dynamic changes(elevated and significantly elevated)in RPR were independent risk factors for 28-day mortality in adult patients with sepsis in ICU,and were independently associated with survival time in adult patients with sepsis in ICU.The most significant independent risk factor is the persistent and significant increase of RPR.Therefore,attention should be paid to sepsis patients with persistent and significant increase of RPR,especially those with significant increase.2.The study found that on the third day after admission to the ICU,the RPR increased group was superior to the RPR significantly increased group in predicting the 28-day prognosis of adult patients with sepsis in ICU.On the 5th day,the RPR significantly increased group was better than the RPR increased group.That is,early elevations may be more informative than significant elevations.A large sample size,multi-center study is needed for further verification.3.Joint model of RPR and SOFA score compared with the single RPR and SOFA score higher AUCs value,when take best cut-off value,it has higher sensitivity,but specific degrees declined slightly,on the first day for parameters,the model prediction efficiency increases obviously,is 28 days of adult sepsis patients prognosis of early prediction model in ICU. |
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