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Background <p>This study aims to investigate the association between the Red cell distribution width to platelet count ratio (RPR) and adverse outcomes in critically ill patients with sepsis-induced coagulopathy (SIC).</p> Methods <p>Clinical data from 7,014 patients admitted to the Intensive Care Unit (ICU) with SIC were extracted from the MIMIC-IV (3.1) database. The study population was divided into four groups based on quartiles of RPR. The primary outcome was 28-day all-cause mortality, and the secondary outcome was ICU mortality. The relationship between RPR and adverse outcomes was explored using Kaplan-Meier curves, Cox proportional hazards regression, restricted cubic spline curves, and subgroup analyses.</p> Results <p>In this study, a total of 7,014 SIC patients were enrolled. RPR was independently associated with both 28-day all-cause mortality and ICU mortality (all <i>p</i> &lt; 0.01). According to Kaplan-Meier curve analysis, the high RPR (≥0.21) group exhibited worse 28-day survival (Log-rank test, <i>p</i> &lt; 0.001). Restricted cubic spline (RCS) curves revealed a nonlinear relationship between RPR and mortality risk (all p for overall &lt; 0.001, all p for nonlinear &lt; 0.05). Threshold effect analysis showed that to the right of the inflection point, the increase in RPR is significantly associated with an increased risk of all-cause mortality in patients. (HR: 1.83, 95% CI: 1.52–2.20). This association remained stable across all subgroups without significant interaction effects.</p> Conclusion <p>The RPR exhibits a “J-shaped” relationship with both 28-day all-cause mortality and ICU mortality in patients with SIC. Both elevated and reduced RPR indices may be associated with early poor prognosis in patients with sepsis-induced coagulopathy.</p> Clinical trial number <p>Not applicable.</p>

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Association between red blood cell distribution width-platelet ratio and mortality in patients with sepsis-induced coagulopathy from the MIMIC-IV database: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月24日

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  • Yichao Zhu,
  • Zhiyu Li,
  • Tao Zhou,
  • Hongyang Xu

摘要

Background

This study aims to investigate the association between the Red cell distribution width to platelet count ratio (RPR) and adverse outcomes in critically ill patients with sepsis-induced coagulopathy (SIC).

Methods

Clinical data from 7,014 patients admitted to the Intensive Care Unit (ICU) with SIC were extracted from the MIMIC-IV (3.1) database. The study population was divided into four groups based on quartiles of RPR. The primary outcome was 28-day all-cause mortality, and the secondary outcome was ICU mortality. The relationship between RPR and adverse outcomes was explored using Kaplan-Meier curves, Cox proportional hazards regression, restricted cubic spline curves, and subgroup analyses.

Results

In this study, a total of 7,014 SIC patients were enrolled. RPR was independently associated with both 28-day all-cause mortality and ICU mortality (all p < 0.01). According to Kaplan-Meier curve analysis, the high RPR (≥0.21) group exhibited worse 28-day survival (Log-rank test, p < 0.001). Restricted cubic spline (RCS) curves revealed a nonlinear relationship between RPR and mortality risk (all p for overall < 0.001, all p for nonlinear < 0.05). Threshold effect analysis showed that to the right of the inflection point, the increase in RPR is significantly associated with an increased risk of all-cause mortality in patients. (HR: 1.83, 95% CI: 1.52–2.20). This association remained stable across all subgroups without significant interaction effects.

Conclusion

The RPR exhibits a “J-shaped” relationship with both 28-day all-cause mortality and ICU mortality in patients with SIC. Both elevated and reduced RPR indices may be associated with early poor prognosis in patients with sepsis-induced coagulopathy.

Clinical trial number

Not applicable.