南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (6): 1256-1266.doi: 10.12122/j.issn.1673-4254.2026.06.06

• • 上一篇    

红细胞分布宽度/红细胞压积与脓毒症患者28 d全因死亡率的关系

王梓渝1(), 伍静雯1, 王涵冰2, 徐艳1, 姜春玲1, 周莉1()   

  1. 1.四川大学 华西医院麻醉科，四川 成都 610041
    2.四川大学 华西临床医学院，四川 成都 610041
  • 收稿日期:2025-08-30 出版日期:2026-06-20 发布日期:2026-06-24
  • 通讯作者: 周莉 E-mail:19197144521@163.com;zlmz@wchscu.cn
  • 作者简介:王梓渝，在读硕士研究生，E-mail: 19197144521@163.com,
  • 基金资助:
    国家自然科学基金(82002084);国家自然科学基金(81971806);四川省科技计划项目(2024NSFC1535);四川省科技计划项目(2023YFH0074)

Elevation of red blood cell distribution width to hematocrit ratio is associated with increased 28-day all-cause mortality in septic patients

Ziyu WANG1(), Jingwen WU1, Hanbing WANG2, Yan XU1, Chunling JIANG1, Li ZHOU1()   

  1. 1.Department of Anesthesiology, West China Medical Center, Chengdu 610041, China
    2.West China School of Medicine, Sichuan University, Chengdu 610041, China
  • Received:2025-08-30 Online:2026-06-20 Published:2026-06-24
  • Contact: Li ZHOU E-mail:19197144521@163.com;zlmz@wchscu.cn
  • Supported by:
    National Natural Science Foundation of China(82002084)

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摘要：

目的 探讨红细胞分布宽度/红细胞压积 （RDW/HCT） 比值与脓毒症患者28 d全因死亡率的相关性。 方法 使用MIMIC-IV数据库进行回顾性分析，并利用eICU-CRD数据库进行验证。分别从上述数据库中纳入27 335例及17 406例成年脓毒症患者。根据RDW/HCT比值四分位数分组，主要结局指标为28 d全因死亡率。采用Kaplan-Meier法评估各组生存率，利用多变量Cox回归模型和限制性立方样条（RCS）分析RDW/HCT比值与28 d死亡风险的相关性，并进行亚组分析。 结果 MIMIC-IV队列和eICU-CRD队列脓毒症患者28 d死亡率分别为19.3%与16.0%。在MIMIC-IV队列中，Kaplan-Meier（K-M）生存曲线显示：RDW/HCT比值升高与28 d死亡风险增加相关（P<0.0001）。多变量Cox回归分析显示：RDW/HCT比值升高是28 d死亡的独立危险因素（HR=1.89，95% CI：1.52~2.36，P<0.001）。RCS分析显示RDW/HCT比值与28 d死亡率呈非线性“U”型关系。亚组分析未发现显著交互作用。eICU-CRD验证队列的结果趋势与MIMIC-IV数据库一致。 结论 RDW/HCT比值升高与脓毒症患者28 d全因死亡率增加相关。

关键词: 脓毒症, 红细胞分布宽度/红细胞压积比值, 28 d全因死亡率, MIMIC-IV/eICU-CRD数据库

Abstract:

Objective 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.

Key words: Sepsis, Red blood cell distribution width/hematocrit, 28-day all-cause mortality, MIMIC-IV/ eICU-CRD database