Prognostic values of red blood cell distribution width, platelet count, and red cell distribution width-to-platelet ratio for severe burn injury

Neutrophil-to-lymphocyte ratio and red blood cell distribution width to platelet ratio and their relationships with inflammatory and antioxidant status in dogs with different stages of heart failure due to myxomatous mitral valve disease

We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RDW/PLT) with other complete blood cell count (CBC) indices and their correlations with serum proinflammatory cytokines, acute phase proteins (APPs), and antioxidant biomarkers in dogs at different stages of heart failure (HF). A total of 29 dogs were divided into four groups according to the ACVIM Consensus Statement: stage-A (healthy/controls, n = 8), stage-B2 (n = 6), stage-C (n = 10), and stage-D (n = 5). Seventeen CBC indices were calculated and correlated with the measurements of inflammatory, APPs, and antioxidant biomarkers, as well as selected echocardiographic variables in all dogs. At stage-C, CBC indices were evaluated 14 days after the treatment. Statistically significant changes were observed only for RDW/PLT and neutrophil-to-lymphocyte ratio (NLR) between groups. NLR increased, but RDW/PLT deceased in dogs with HF, compared to controls (P < 0.05). There were no statistically differences between pre- and post-treatment CBC indices. There were significantly positive and negative correlations between the CBC indices, serum parameters and selected echocardiographic variables in dogs with HF(P < 0.05). ROC analysis showed the best sensitivity (57% and 68%) and specificity (100% and 57%) for NLR > 5.8 and RDW/PLT ≤ 0.057 for predicting the severity of HF, respectively. Results showed that NLR and RDW/PLT may have potential for monitoring severity of the disease and the effect of treatment in dogs with HF. Imbalances between indices of circulating blood cells can contribute to immunoinflammatory and antioxidant responses in pathogenesis of canine HF, which may provide us alternative targets to develop new diagnostic and therapeutic strategies in veterinary medicine.

Effects of peripheral blood cells on ischemic stroke: Greater immune response or systemic inflammation?

Ischemic stroke is still one of the most serious medical conditions endangering human health worldwide. Current research on the mechanism of ischemic stroke focuses on the primary etiology as well as the subsequent inflammatory response and immune modulation. Recent research has revealed that peripheral blood cells and their components are crucial to the ensuing progression of ischemic stroke. However, it remains unclear whether blood cell elements are principally in charge of systemic inflammation or immunological regulation, or if their participation is beneficial or harmful to the development of ischemic stroke. In this review, we aim to describe the changes in peripheral blood cells and their corresponding parameters in ischemic stroke. Specifically, we elaborate on the role of each peripheral component in the inflammatory response or immunological modulation as well as their interactions. It has been suggested that more specific therapies aimed at targeting peripheral blood cell components and their role in inflammation or immunity are more favorable to the treatment of ischemic stroke.

Cardiopulmonary exercise test combined with red blood cell distribution width to predict cardiovascular complication of thoracic surgery

Cardiovascular complications in patients undergoing thoracic surgery, which physicians have a limited ability to predict, are often unavoidable and resulting in adverse outcome. Cardiopulmonary exercise testing (CPET), the gold standard of cardiopulmonary function evaluation, has also been proved to be a preoperative risk assessment tool. Meanwhile, elevated red blood cell distribution width (RDW) has surged as a biochemical marker in the occurrence of cardiovascular disease. However, it is yet unclear the value of CPET combined with RDW in predicting cardiovascular complications after thoracic surgery. 50 patients with cardiovascular complications after thoracic surgery were collected as the case group, and 100 thoracic surgery patients were recruited as the control group, with the same gender, age ± 2 years old, and no postoperative complications. After admission, all patients underwent CPET and RDW inspection before surgery, and the results were recorded. The CPET parameter oxygen pulse (VO2/HR) and RDW of the case group were lower than those of the control group (P < 0.05), and the ventilation/carbon dioxide production (VE/VCO2 slope) was significantly higher than control group (P < 0.01). The biochemical parameters hemoglobin (Hb) and Glomerular filtration rate (GFR)) of the case group were lower than those of the control group (P < 0.05), the homocysteine (hCY), creatinine (Cr), operation time and blood loss of the case group were higher than those of the control group (P < 0.05). The RDW had a negative correlation with VO2 max in both overall and control group. The combination of VO2/kg and RDW had the highest diagnostic value in predicting cardiovascular complications. The combination of VO2/kg and RDW has predictive diagnostic value and is more suitable for predicting postoperative complications of thoracic surgery.

Diagnostic value of procalcitonin and red blood cell distribution width at admission on the prognosis of patients with severe burns: A retrospective analysis

The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut-off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single-factor and multiple-factor COX regression. Kaplan-Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662-0.860, P < .001), 0.687 (95% CI, 0.554-0.820, P = .003) respectively, and the optimal cut-off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan-Meier survival analysis showed that there was a significant difference in the 90-day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log-rank: 24.162; P < .001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90-day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log-rank: 14.404; P < .001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90-day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors.

Feasibility of using red cell distribution width for prediction of postoperative mortality in severe burn patients: an association with acute kidney injury after surgery

BACKGROUND

Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients.

METHODS

We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI).

RESULTS

The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667-0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138-1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378- 2.046; P < 0.001).

CONCLUSIONS

Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.

Red blood cell distribution width to platelet ratio in neonatal foals with sepsis

BACKGROUND

Rapid and accurate markers to aid diagnosis of sepsis are needed in neonatal foals. The CBC variable red blood cell distribution width (RDW) to platelet ratio (RPR) is associated with inflammatory response and linked to poor outcomes of sepsis in human patients.

HYPOTHESIS

Explore the correlation of RPR with sepsis in neonatal foals and evaluate RPR predictive and prognostic value.

ANIMALS

Three hundred seventeen hospitalized neonatal foals ≤7 days of age that had a CBC and physical exam performed at admission between 2012 and 2021.

METHODS

Retrospective case-control study. Clinical records were used to calculate sepsis scores and define groups. Red blood cell distribution width to platelet ratio was calculated and compared between groups (septic vs nonseptic) based on Kruskal-Wallis and Wilcoxon signed-rank tests. A multivariate logistic regression model to predict sepsis was created. The cutoff for RPR was obtained based on the maximal Youden Index. The Kaplan-Meier method and the log-rank test were used to estimate survival curves and compare survival rates based on RPR.

RESULTS

Red blood cell distribution width to platelet ratio was significantly higher in septic foals (Median = 0.099, confidence interval [CI] [0.093; 0.108]) than in sick nonseptic (0.085, CI [0.083; 0.089]) and healthy foals (0.081, CI [0.077; 0.086]; P < .0001). Red blood cell distribution width to platelet ratio was able to predict sepsis with high accuracy (AUC = 82.1%). The optimal RPR cutoff for sepsis was 0.09.

CONCLUSIONS AND CLINICAL IMPORTANCE

Red blood cell distribution width to platelet ratio calculation is practical, inexpensive, and based on CBC-derived data. Calculation of RPR along with CBC can aid in the diagnosis of sepsis and estimation of outcome.

Red Cell Distribution Width-to-Platelet Count Ratio: A Promising Predictor of In-Hospital All-Cause Mortality in Critically Ill Patients with Acute Ischemic Stroke

INTRODUCTION

The red blood cell distribution width-to-platelet ratio (RPR), a novel inflammatory index, has already been proven as a prognostic factor in some other diseases, but its prognostic effect on critically ill patients with acute ischemic stroke (AIS) has been rarely investigated. This study aimed to investigate the association between RPR and in-hospital mortality in these patients.

METHODS

We extracted clinical data from the Medical Information Mart for Intensive Care IV 1.0 database. The primary outcome was in-hospital all-cause mortality of patients with critical AIS. The main independent variable was RPR. To investigate the association between RPR and in-hospital all-cause mortality in patients with critical AIS, multivariable logistic analyses, smooth curve fitting, and stratified analyses were conducted.

RESULTS

In total, 2,673 patients with AIS who were admitted to the intensive care unit were included in the study. In the multivariable analysis, in-hospital mortality was positively related to RPR (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.02-1.59). According to the two-piecewise logistic regression model, we found that the inflection point of RPR was 1.89%. To the left of the inflection point (RPR ≤1.89%), we did not detect any relationship between RPR and in-hospital all-cause mortality (OR [95% CI]: 0.73 [0.41, 1.31], p = 0.2884). In contrast, to the right of the inflection point (RPR >1.89%), RPR was positively related to in-hospital all-cause mortality (OR [95% CI]: 1.61 [1.18, 2.19], p = 0.0027).

CONCLUSIONS

RPR showed a nonlinear relationship with in-hospital all-cause mortality in patients with critical AIS.

Red blood cell distribution width/platelet ratio on admission as a predictor for in-hospital mortality in patients with acute myocardial infarction: a retrospective analysis from MIMIC-IV Database

BACKGROUND

Red blood cell distribution width (RDW) to platelet ratio (RPR) is a novel inflammatory indicator. It integrates the risk prediction of RDW and platelet, which is associated with adverse outcomes. However, the predictive power of RPR in mortality for patients with acute myocardial infarction (AMI) remains uncertain. Thus, we aimed to explore the association between RPR and 180-day in-hospital mortality in patients with AMI.

METHODS

Data on patients with AMI were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into two groups according to the optimal RPR cut-off value. The survival curve between high and low RPR groups was plotted via the Kaplan-Meier (KM) method. Univariate and multivariate Cox regression analyses were performed to determine the association between RPR on admission and 180-day in-hospital mortality.

RESULTS

A total of 1266 patients were enrolled, of which 83 (6.8%) died within 180 days during the hospitalization. Compared with the survivor group, the non-survivor group had higher RPR on admission (0.11 ± 0.07 vs. 0.08 ± 0.06, P < 0.001). The KM curve indicated that the survival probability of low RPR group was higher than that of high RPR group. Multivariate Cox regression analysis demonstrated that higher RPR on admission was an independent and effective predictor of 180-day mortality in patients with AMI (hazard ratio [HR]: 2.677, 95% confidence interval [CI]: 1.159-6.188, P = 0.021).

CONCLUSION

Higher RPR was associated with higher in-hospital 180-day mortality in patients with AMI.

Association of red cell distribution width (RDW) and the RDW to platelet count ratio with cardiovascular disease among US adults: a cross-sectional study based on the National Health and Nutrition Examination Survey 1999-2020

OBJECTIVE

To investigate the association between red cell distribution width (RDW) and the RDW to platelet count ratio (RPR) and cardiovascular diseases (CVDs) and to further investigate whether the association involves population differences and dose-response relationships.

DESIGN

Cross-sectional population-based study.

SETTING

The National Health and Nutrition Examination Survey (1999-2020).

PARTICIPANTS

A total of 48 283 participants aged 20 years or older (CVD, n=4593; non-CVD, n=43 690) were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the presence of CVD, while the secondary outcome was the presence of specific CVDs. Multivariable logistic regression analysis was performed to determine the relationship between RDW or the RPR and CVD. Subgroup analyses were performed to test the interactions between demographics variables and their associations with disease prevalence.

RESULTS

A logistic regression model was fully adjusted for potential confounders; the ORs with 95% CIs for CVD across the second to fourth quartiles were 1.03 (0.91 to 1.18), 1.19 (1.04 to 1.37) and 1.49 (1.29 to 1.72) for RDW (p for trend <0.0001) compared with the lowest quartile. The ORs with 95% CIs for CVD across the second to fourth quartiles were 1.04 (0.92 to 1.17), 1.22 (1.05 to 1.42) and 1.64 (1.43 to 1.87) for the RPR compared with the lowest quartile (p for trend <0.0001). The association of RDW with CVD prevalence was more pronounced in females and smokers (all p for interaction <0.05). The association of the RPR with CVD prevalence was more pronounced in the group younger than 60 years (p for interaction=0.022). The restricted cubic spline also suggested a linear association between RDW and CVD and a non-linear association between the RPR and CVD (p for non-linear <0.05).

CONCLUSION

There are statistical heterogeneities in the association between RWD, RPR distributions and the CVD prevalence, across sex, smoking status and age groups.

Red cell distribution width values and red cell distribution width-to-platelet ratio in Thoroughbred foals in the first 24 hours of life

OBJECTIVES

To report red cell distribution width (RDW) values, to calculate RDW-to-platelet ratio (RPR), and to investigate a possible correlation of RDW and RPR index values in neonatal foals classified as healthy or at risk based on clinical information from a population of foals up to 24 hours of life.

DESIGN

Retrospective study conducted from records and CBCs of foals born between June and November from 2018 to 2020 foaling seasons.

SETTING

Breeding farm.

ANIMALS

Three hundred and nine neonatal full-term Thoroughbred foals.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Foals were evaluated by a veterinarian within 15 minutes after birth, and a blood sample was collected within 24 hours of life. Based on clinical information, 88 of 309 foals (28.4%) were considered at risk of perinatal disease, and 201 were healthy. Mean gestational age for the foals was 346.3 ± 9.7 days. RDW values did not differ between groups. Gestational length demonstrated to have a negative correlation with RDW (r = -0.156, P = 0.005) and mean corpuscular volume (r = -0.135, P = 0.01), indicating a link of these variables to foal maturity. RPR index was higher for at-risk (0.073 ± 0.018) than for healthy foals (0.068 ± 0.014, P = 0.01).

CONCLUSION

RPR might be a promising early indicator of disease for the field triage of neonatal foals.

An Increase in Admission RDW Value Is Associated with Excess Short-Term Mortality Rates in Patients with Severe Burns

The predictive value of red blood cell distribution width (RDW) in severely burned patients remains unclear. This study aimed to investigate the potential association between admission RDW and outcomes in patients with severe burns. Data of severely burned patients in the burn center of Changhai Hospital were retrospectively evaluated. The relationship between admission RDW and mortality was analyzed and displayed using the receiver operating characteristic curve, Kaplan-Meier curve, Cox proportional hazards regression, and the nomogram method. A total of 342 patients were identified according to the filter criteria. The 30-day mortality was 12.9%, and the mortality rates in 7 days and 90 days were 2.9% and 16.7%, respectively. Patients with high admission RDW value were more likely to die than those with low RDW value. Multivariate analysis revealed that higher admission RDW, age, full-thickness burned area, and inhalation injury were independent risk factors with 30-day mortality. The nomogram based on these risk factors was established to predict survival probability in severe burn patients. The C-index of different follow-up times was computed between 0.867 and 0.904, and the nomogram model list fits the data well. Admission RDW played a valuable role in predicting short-term mortality in patients with severe burns. The nomogram containing admission RDW was established to predict mortality, which helps burn care providers identify the patients at higher risk of short-term mortality after severe burns. More attention should be paid to the application of these easy and inexpensive biochemical indicators in the early prediction of disease progression.

Association of Red Cell Distribution Width-to-Platelet Ratio and Mortality in Patients with Sepsis

Background

As a novel inflammatory index, the ratio of red cell distribution width (RDW) to platelet count (RPR) may have prognostic value in some critical illnesses. However, studies on the prognostic influence of RPR in patients with sepsis are few. This study is aimed at investigating the association between RPR levels and 28-day mortality in patients with sepsis.

Methods

Data of patients with sepsis were obtained from the Medical Information Mart for Intensive Care III database. The best cut-off value was calculated by establishing the receiver operating characteristic curve (ROC), and the predictive ability of different indicators was compared through the area under the curve (AUC). The association between RPR levels and 28-day mortality was assessed using the Cox proportional hazards model. Restrictive cubic spline analysis was applied to the multivariable Cox model to investigate the nonlinear relationship between RPR and 28-day mortality.

Results

A total of 3367 patients with sepsis were included in the study. A nonlinear relationship was observed between RPR and 28-day mortality, showing a trend of a first rapid increase and a gradual increase. For the prediction of mortality, the best cut-off value for RPR was 0.109, with an AUC of 0.728 (95% confidence interval [CI]: 0.709–0.747). The predictive capability of RPR was superior to those of RDW, platelet, SOFA score, and SAPS II score. After adjusting for various confounding factors, high RPR was significantly associated with increased mortality with adjusted hazard ratios of 1.210 (95% CI: 1.045–1.400) for categorical variables and 2.826 (95% CI: 2.025–3.944) for continuous variables.

Conclusion

Elevated RPR level is significantly correlated with a high risk of 28-day mortality in patients with sepsis and can be a new predictor of patient prognosis.

Enhanced red blood cell distribution width to platelet ratio is a predictor of mortality in patients with sepsis: a propensity score matching analysis based on the MIMIC-IV database

OBJECTIVE

To explore the association between dynamic changes in red blood cell distribution width to platelet count ratio (RPR) during hospitalisation and short-term mortality in patients with sepsis.

DESIGN

A retrospective cohort study using propensity score matching.

SETTING

Intensive care units (ICUs) of Beth Israel Deaconess Medical Center.

PARTICIPANTS

A total of 8731 adult patients with sepsis were included in the study. The patients were identified from the ICU of the Medical Information Mart for Intensive Care database. The observed group included patients who experienced an increase in RPR of more than 30% during the first week of ICU admission, whereas the control group included the rest.

MAIN OUTCOME AND MEASURE

Using propensity score matching, a matched control group was created. The primary outcome was 28-day mortality, and the length of hospital stay and in-hospital mortality were the secondary outcomes.

RESULTS

The difference was evident in 28-day mortality between the two groups (85.8% vs 74.5%, p<0.001, Kaplan-Meier analysis, and HR=1.896, 95% CI=1.659 to 2.168, p<0.001, Cox regression). In the secondary outcomes, there was a significant difference in in-hospital mortality (p<0.001). In addition, the study discovered that the observed groups had a significantly longer hospital stay (p<0.001). Meanwhile, the results of subgroup analyses were consistent with those of the primary analyses.

CONCLUSIONS

In patients with sepsis, a significantly increased RPR is positively associated with the short-term death rate. Continuous RPR monitoring could be a valuable measure for predicting short-term mortality in patients with sepsis.

Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: a retrospective analysis of the MIMIC-IV database

OBJECTIVES

We aimed to investigate the association between red cell distribution width-to-platelet ratio (RPR), and in-hospital mortality in critically ill patients with acute myocardial infarction (AMI).

DESIGN

A retrospective cohort study.

SETTING

Data were collected from the Medical Information Mart for Intensive Care database (MIMIC-IV) consisting of critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Centre in Boston.

PARTICIPANTS

A total of 5067 patients with AMI were enrolled from the MIMIC-IV database.

PRIMARY AND SECONDARY OUTCOME

In-hospital mortality.

RESULTS

A total of 4034 patients survived, while 1033 died. In a multiple regression analysis adjusted for age, weight and ethnicity, RPR also showed a positive correlation with in-hospital mortality (HR 1.91, 95% CI 1.42 to 2.56, p<0.0001). Moreover, after adjusting for additional confounding factors, obvious changes were observed (HR 1.63, 95% CI 1.03 to 2.57, p=0.0357). In model 2, the high ratio quartile remained positively associated with hospital mortality compared with the low ratio quartile (HR 1.20, 95% CI 1.01 to 1. 43), with a p-value trend of 0.0177. Subgroup analyses showed no significant effect modifications on the association between RPR and in-hospital mortality in the different AMI groups (p>0.05).

CONCLUSION

RPR is an independent predictor of in-hospital mortality in critically ill patients with AMI.

Prediction of Mortality after Burn Surgery in Critically Ill Burn Patients Using Machine Learning Models

Severe burns may lead to a series of pathophysiological processes that result in death. Machine learning models that demonstrate prognostic performance can be used to build analytical models to predict postoperative mortality. This study aimed to identify machine learning models with the best diagnostic performance for predicting mortality in critically ill burn patients after burn surgery, and then compare them. Clinically important features for predicting mortality in patients after burn surgery were selected using a random forest (RF) regressor. The area under the receiver operating characteristic curve (AUC) and classifier accuracy were evaluated to compare the predictive accuracy of different machine learning algorithms, including RF, adaptive boosting, decision tree, linear support vector machine, and logistic regression. A total of 731 patients met the inclusion and exclusion criteria. The 90-day mortality of the critically ill burn patients after burn surgery was 27.1% (198/731). RF showed the highest AUC (0.922, 95% confidence interval = 0.902–0.942) among the models, with sensitivity and specificity of 66.2% and 93.8%, respectively. The most significant predictors for mortality after burn surgery as per machine learning models were total body surface area burned, red cell distribution width, and age. The RF algorithm showed the best performance for predicting mortality.

Prognostic Values of Platelet Distribution Width and Platelet Distribution Width-to-Platelet Ratio in Severe Burns

BACKGROUND

Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values in severe burns have not been reported.

OBJECTIVE

To investigate the early time course of PDW and PPR in severe burn patients and investigate their prognostic values.

METHODS

This is a 16-year, single-center retrospective study of 590 severe burn patients. The complete blood count parameters on day 1, day 3, and day 7 postburn, including PDW and PPR, were collected. Receiver operating characteristic curves (ROC) analysis, multiple logistic regression analysis and Kaplan-Meier survival analysis were performed to evaluate the prognostic values of PDW and PPR in severe burn patients.

RESULTS

According to 120-day follow-up records, 96 patients were nonsurvivors and 494 patients were survivors. ROC and area under the curve (AUC) analysis showed that, for predicting 120-day prognosis, the AUC of PDW (0.782) and PPR (0.816) on day 3 was the highest, followed by the AUC of PDW (0.764) and PPR (0.750) on day 7. The ROC-AUC of PPR (0.816) on day 3 was very close to that of the ABSI score (0.818). Multiple logistic regression analysis showed that the PDW (P = 0.033 and P = 0.009) and PPR (P = 0.052 and P = 0.046) on day 3 and day 7 were all significantly independently positively associated with 120-day mortality. Kaplan-Meier survival analysis showed that high PDW and PPR were both significantly associated with a high 120-day mortality rate on day 3 and day 7.

CONCLUSION

PDW and PPR on day 3 and day 7 were independent risk factors for 120-day mortality in severe burn patients. These objective and readily available prognostic indicators may be more clinically favored.

Blood Indices In Adult Acute Burn: A Window Into Milieu Interieur - The Future Biomarkers?

Optimal treatment of sepsis in burned patients depends on early diagnosis and includes prompt administration of antimicrobials as well as management of hemodynamic alterations and other organ dysfunctions. The role of red blood cell distribution width (RDW) and platelet indices in prognosticating and identifying sepsis in acute burn patients is studied. This study was done as a prospective study over 18 months, including patients in the age group >18 or <60 years, with burns >20% and <70% TBSA, burn time to resuscitation time 24 hours or less and with thermal and scald burns. Data of 157 patients were analyzed and the following observations were made. The mean age of the study population was 31.36 years (18-59 years). RDW values were higher in the non-survivor group. Platelet count and plateletcrit were higher in the survivor group and the no sepsis group. Positive rising trends of platelet count and plateletcrit were seen in the survivor group. Day 1, 3, 7 values of RDW, platelet count and plateletcrit were significant in determining the outcome of the patient on mortality and sepsis related morbidity of the patient. RDW, platelet count and plateletcrit in combination can predict mortality and sepsis as early as the third day, thus giving a clinical advantage of initiating targeted treatment to the at-risk burn population before sepsis is detected clinically. This could better the outcomes in treatment of burn patients.

Possible indicators of amputation and insufficient perfusion after heat press injury: A retrospective study

INTRODUCTION

Amputation outcome after heat press injury is associated with insufficient perfusion. We aimed to determine other risk factors for heat press injury and mechanisms of insufficient perfusion associated with amputation.

METHODS

We retrospectively classified 120 inpatients into the emergency and clinic groups, with arrival time before and after 48 h of injury, respectively. We performed propensity score-match to identify significant variables and combine them with those previously identified. Patients with or without amputation were categorized in different subgroups according to arrival time and perfusion with receiver-operator-characteristic (ROC) curves.

RESULTS

In the emergently insufficient perfusion subgroup, red blood cell distribution width of standard deviation (RDW-SD) was statistically different between patients without and with amputation (cutoff = 43 fL; specificity = 0.909). In the urgent group, neutrophil-lymphocyte-ratio (NLR) and relative lymphocyte count (L%) showed no association with perfusion, but was associated with amputation (NLR cutoff value = 3.12; sensitivity = 0.846). Differential leukocytes and related ratios (both groups), D-dimer (emergency group), and creatine kinase (CK) (clinic group) were also associated with insufficient perfusion.

CONCLUSION

The study showed some correlations. Inflammation variables, D-dimer, and CK were associated with amputation and perfusion after heat press injury. Several factors were associated with amputation, including RDW-SD increase in insufficiently perfused patients within 48 h of injury, and NLR increase and L% decrease in patients after 48 h post-injury.

A Prognostic Model Incorporating Red Cell Distribution Width to Platelet Ratio for Patients with Traumatic Brain Injury

BACKGROUND

As an inflammation-based marker, red cell distribution width to platelet ratio (RPR) has been verified to be associated with disease severity and outcome in many clinical settings. We designed this study to evaluate the prognostic value of RPR in patients with traumatic brain injury (TBI).

METHODS

A total of 420 patients admitted with TBI were included in this study. Laboratory and clinical data were collected from an electronic medical record system. Univariate and multivariate logistic regression analyses were sequentially performed to discover risk factors of in-hospital mortality. Receiver operating characteristic (ROC) curves were drawn to confirm the predictive value of different markers including RPR in training set and testing set.

RESULTS

Non-survivors had higher level of RPR than survivors (P<0.001). Logistic regression analysis showed that RPR was significantly associated with mortality even after adjusting for confounding factors (P<0.001). The area under the ROC curve (AUC) value of Glasgow Coma Scale (GCS) for predicting mortality was 0.761 and 0775 in training set and testing set, respectively. And the constructed predictive model incorporating RPR had the highest AUC value of 0.858 and 0.884 in training set and testing set.

CONCLUSION

RPR is significantly associated with mortality in TBI patients. Utilizing RPR to construct a predictive model is valuable to evaluate prognosis of TBI patients.

Prognostic Value of the Red Cell Distribution Width in Patients with Sepsis-Induced Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

Objective

The prognostic value of the red cell distribution width (RDW) in patients with sepsis-induced acute respiratory distress syndrome (ARDS) is still elusive. This study is aimed at determining whether RDW is a prognostic indicator of sepsis-induced ARDS.

Methods

This retrospective cohort study included 1161 patients with sepsis-induced ARDS. The datasets were acquired from the Medical Information Mart for Intensive Care III database. The locally weighted scatter-plot smoothing technique, Cox regression, Kaplan-Meier estimator, and subgroup analysis were carried out to evaluate the association between RDW and 90-day mortality.

Results

The RDW and mortality had a roughly linear increasing relationship. The Cox regression model results were as follows: for level 2 (14.5% < RDW < 16.2%), hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.03–1.77, and for level 3 (RDW ≥ 16.2%), HR = 2.07, 95% CI = 1.59–2.69. The following results were obtained when RDW was treated as a continuous variable: HR = 1.11, 95%CI = 1.06–1.15. The P values of the interaction between the RDW and covariates were greater than 0.05.

Conclusion

RDW is a new independent prognostic marker for patients with sepsis-induced ARDS.

Red Cell Distribution Width to Platelet Count Ratio: A Promising Routinely Available Indicator of Mortality for Acute Traumatic Brain Injury

Prognosis evaluation is crucial for the effective management of patients with acute traumatic brain injury (TBI). However, there is still a lack of routinely available blood indicators for mortality risk in clinical practice. To investigate whether blood red cell distribution width to platelet count ratio (RPR) correlates with hospital mortality of TBI, clinical data of 2220 patients with TBI were extracted from two large intensive care unit cohorts (MIMIC-III and eICU Database), and were integratively analyzed using our developed method named MeDICS. We found that higher RPR can be observed among non-survivors than survivors of TBI (p < 0.001). It had a moderately good prognostic performance for mortality with an area under receiver-operating characteristic curve (AUC) of 0.7367, which was greater than that of Glasgow Coma Scale (GCS; AUC = 0.6022). Besides, the nomogram consisting of RPR, GCS, and other risk factors was developed, where 10-fold cross-validation was performed to protect it against overfitting. A Harrell's C-index of 0.8523 was determined, suggesting an improved prognostic value based on RPR. The in vivo experiments further confirmed the association between RPR and neuro-outcome after TBI. It indicated that the continuous change in RPR post-injury is attributed to the development of inflammation, which emphasized the importance of controlling inflammatory response in clinical treatment. Taken together, RPR is a promising routinely available predictor of mortality for acute TBI. The nomogram generated from it can be used in resource-limited settings, thus be proposed as a prognosis evaluation aid for patients with TBI in all levels of medical system.

C-Reactive Protein-to-Albumin Ratio Predicts Sepsis and Prognosis in Patients with Severe Burn Injury

Background

Sepsis is a leading cause of mortality among severe burns. This study was conducted to investigate the predictive role of C-reactive protein-to-albumin ratio (CAR) for sepsis and prognosis in severe burns.

Methods

Patients with severe burn injuries from 2013 to 2017 were enrolled and divided into septic and nonseptic groups based on the presence of sepsis within 30 days postburn. Independent risk factors for sepsis were performed by the univariate and multivariate logistic regression analyses. The association between CAR level at admission and postburn 30-day mortality was designed via the Kaplan–Meier method.

Results

Of all the 196 enrolled patients, 83 patients developed sepsis within 30 days postburn injury, with an incidence of 42.3%. TBSA percentage (OR: 1.65, 95% CI: 1.17-2.32, P = 0.014) and CAR at admission (OR: 2.25, 95% CI: 1.33-3.56, P = 0.009) were the two independent risk factors for sepsis in severe burns by the multivariate logistic regression analysis. A higher CAR level (≥1.66) at admission was associated with a lower postburn 30-day survival rate (P = 0.005).

Conclusions

The CAR level at admission was an independent risk factor for sepsis and prognosis in severe burns.

Plasma Neutrophil-to-Lymphocyte Ratio on the Third Day Postburn is Associated with 90-Day Mortality Among Patients with Burns Over 30% of Total Body Surface Area in Two Chinese Burns Centers

INTRODUCTION

Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. This study aimed to evaluate the potential role of NLR to predict 90-day mortality.

METHODS

Data of 577 patients with burns over 30% of total body surface area were collected and retrospectively analyzed. The risk factors for 90-day mortality were evaluated using logistic regression analyses. Receiver operating characteristic (ROC) curve analysis of the 3rd day NLR was performed and the optimal cut-off value was calculated. The 90-day mortality rates were compared between high and low NLR groups using Kaplan-Meier analysis.

RESULTS

Age, mechanical ventilation, burn index, 3rd day NLR, and 7th day red blood cell and platelet (PLT) counts were found to be independent predictive values for 90-day mortality. In contrast, percentage of total body surface area burned, inhalation injury, 1st day white blood cell and neutrophil counts, the 3rd day lymphocytes and PLT counts, and 7th day hemoglobin level were not independently associated with 90-day mortality. The area under the ROC curve of the 3rd day NLR for severe burn-delayed death prediction was 0.665 (95% confidence interval, 0.591-0.739), and the optimal cut-off value of the 3rd day NLR was 10.50. The 90-day mortality rates differed significantly between the NLR >10.5 group and the NLR ≤ 10.5 group (17.03% vs 5.92%, respectively; P < 0.01).

CONCLUSION

These results suggested that the 3rd day NLR was associated with an increased risk of death in severely burned patients; thus, it can provide useful information to predict 90-day mortality.

The Combination of Hemogram Indexes to Predict Exacerbation in Stable Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammatory processes, and exacerbation of COPD represents a critical moment in the progression of COPD. Several biomarkers of inflammation have been proposed to have a predictive function in acute exacerbation. However, their use is still limited in routine clinical practice. The purpose of our study is to explore the prognostic efficacy of novel inflammatory hemogram indexes in the exacerbation among stable COPD patients. Method: A total of 275 stable COPD patients from the Shanghai COPD Investigation Comorbidity Program were analyzed in our study. Blood examinations, especially ratio indexes like platelet-lymphocyte ratio (PLR), platelet × neutrophil/lymphocyte ratio [systemic immune-inflammation index (SII)], and monocyte × neutrophil/lymphocyte ratio [systemic inflammation response index (SIRI)], lung function test, CT scans, and questionnaires were performed at baseline and routine follow-ups. Clinical characteristics and information of exacerbations were collected every 6 months. The relationship between hemogram indexes and diverse degrees of exacerbation was assessed by logistic regression. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the ability of hemogram indexes to predict exacerbation of COPD. Furthermore, the discrimination and accuracy of combined indexes were measured by ROC and calibration curve. Result: There was a significant positive correlation between PLR levels and total exacerbation of COPD patients in a stable stage in a year. Also, the predictive ability of PLR exceeded any other ratio indexes, with an AUC of 0.66. SII and SIRI ranked second only to PLR, with an AUC of 0.64. When combining PLR with other indexes (sex, COPD year, and St. George's Respiratory Questionnaire scores), they were considered as the most suitable panel of index to predict total exacerbation. Based on the result of the ROC curve and calibration curve, the combination shows optimal discrimination and accuracy to predict exacerbation events in COPD patients. Conclusion: The hemogram indexes PLR, SII, and SIRI were associated with COPD exacerbation. Moreover, the prediction capacity of exacerbation was significantly elevated after combining inflammatory hemogram index PLR with other indexes, which will make it a promisingly simple and effective marker to predict exacerbation in patients with stable COPD.

The Association of Red Blood Cell Distribution Width to Platelet Count Ratio and 28-Day Mortality of Patients with Sepsis: A Retrospective Cohort Study

Background

Sepsis is a life-threatening and inflammatory disease with high morbidity and mortality. Red blood cell distribution width to platelet count ratio (RPR) was known as an inflammatory biomarker and was related to poor outcomes of various diseases.

Aim

This study was intended to explore the association between RPR and mortality of sepsis patients.

Methods

A retrospective cohort study was undertaken in patients with sepsis, and the data were collected from a public database called Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was 28-day mortality while the secondary outcomes were 90-day mortality and ICU mortality. Multivariable regression analyses, as well as interaction and stratified analyses, were conducted to investigate the relation between RPR and sepsis mortality.

Results

In total, we enrolled 7531 patients with 1316 deaths. RPR was independently correlated with 28-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.02–1.06), 90-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.03–1.06) and ICU mortality (per 0.1 increase: OR=1.06; 95% CI 1.02–1.10). Twenty-eight-day survival was worse in the high RPR (≥0.134) group according to the Kaplan–Meier curve analyses (Log rank test, p<0.001). In stratified analyses, Sequential Organ Failure Assessment (SOFA) score and length of ICU stay had interactive effects with the high RPR (≥0.134) group on 28-day mortality.

Conclusion

RPR is a novel biomarker that indicates poor prognosis of sepsis patients. Clinicians are required to pay more attention to those patients with high RPR.

An Evaluation of the Different Serum Markers Associated with Mortality in Crimean-Congo Hemorrhagic Fever

BACKGROUND

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease with a high mortality rate. Although CCHF has been widely investigated over the past decade, a review of the literature indicated no data on the prognostic capacity of the mean platelet volume-to-platelet count ratio (MPVPCR) and the red cell distribution width-to-platelet count ratio (RDWPCR) for the systemic inflammatory response in patients with CCHF. This study aimed to evaluate the prognostic ability of MPVPCR and RDWPCR on mortality in patients with CCHF.

METHODS

A total of 807 patients that were admitted to the Cumhuriyet University Hospital's Emergency Department from January 2010 to December 2018 were involved. The RDWPCR and MPVPCR were separately calculated via absolute blood red cell and platelet counts at the time of admission. Before performing receiver-operating characteristic (ROC) curve analysis to define the optimum cut-off values of MPVPCR and RDWPCR stepwise logistic regression analysis was used to determine the predictive factors related to mortality in CCHF patients.

RESULTS

Values of both MPVPCR and RDWPCR were significantly lower in survivors than in non-survivors (MPVPCR: 0.20±0.23 versus 0.55±0.55, P<0.001; RDWPCR: 0.27±0.32 versus 0.77±0.77, P<0.001, respectively). The MPVPCR (odds ratio [OR], 5.95; P=0.048) was an independent predictor for the prognosis of mortality in CCHF patients. The area under the curve in the ROC curve analysis for MPVPCR was 0.876 with a cut-off of 0.21 (sensitivity 87%, specificity 76%).

CONCLUSION

At the time of admission, MPVPCR might be a useful predictor of mortality in patients with CCHF.

Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients

Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume, as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients. Adult burned patients admitted to the National Burn Center in Uruguay between May 2017 and February 2018 (discovery cohort) and between March 2018 and August 2019 (validation cohort) were included. Patients' characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5, and 7 after thermal injury. Eighty-eight patients were included in the discovery cohort. Total body surface area burned was 14 [7-23]% and mortality was 15%. Nonsurvivors presented higher RDW and mean platelet volume (P < .01). NLR decreased after admission in all patients (P < .01), but was higher in nonsurvivors (P < .01). Deceased patients also presented higher RPR on days 3, 5, and 7 (P < .001). On the contrary, PLR was reduced in nonsurvivors (P < .05). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR, and RPR could identify patients with increased mortality. These findings were confirmed in the validation cohort (n = 95). Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.

Red cell distribution width-to-lymphocyte ratio: A novel predictor for HBV-related liver cirrhosis

To evaluate the diagnostic power of red cell distribution width-to-lymphocyte ratio (RLR) for HBV-related liver cirrhosis via a retrospective cohort study.Seven hundred fifty healthy controls, 327 chronic hepatitis B (CHB) patients, and 410 patients with HBV-related liver cirrhosis (HBV-LC) were enrolled in this study. RLR, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), AST to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) were compared between the 3 groups. The predictive powers of RLR and RDW for HBV-related liver cirrhosis and patient prognosis were evaluated using AUROC.Patients with HBV-related liver cirrhosis had higher RLR, FIB-4, NLR, RDW, APRI, and lower LMR compared with the control and CHB groups. RLR in the HBV-LC group was significantly higher than both CHB and control groups (both P < .05). While RLR in the CHB group was also higher than the control group, the difference was not statistically significant (P > .05). The AUROC of RLR for predicting HBV-related liver cirrhosis was 0.87, and was superior to RDW (0.81), FIB-4 (0.79), and APRI (0.60). With an optimized cut-off value (10.87), RLR had the highest sensitivity (0.88) and specificity (0.72), and was superior to RDW (0.86, 0.64), FIB-4 (0.80, 0.65), and APRI (0.85, 0.48) as a biomarker. For all 3 groups, RLR was negatively correlated (all P < .05) with serum platelet (PLT) and was positively correlated (all P < .05) with FIB-4 and APRI. There was no significant statistical difference in RLR for patients in HBV-LC group who had different prognosis (P > .05).The RLR, a routinely available, inexpensive, and easily calculated measure, can be used as a predictor of HBV-related liver cirrhosis, but not as a predictor of prognosis for patients with liver cirrhosis. Use of RLR may reduce the need for frequent liver biopsies in CHB patients.

Association between red cell distribution width-to-platelet ratio and hepatic fibrosis in nonalcoholic fatty liver disease: A cross-sectional study

BACKGROUND

We aimed to assess the association between red cell distribution width-to-platelet ratio (RPR) and hepatic fibrosis in nonalcoholic fatty liver disease.

METHODS

The 388 subjects fulfilling the diagnostic criteria of Nonalcoholic fatty liver disease (NAFLD) were enrolled in this cross-sectional study. Red cell distribution, platelet, and other clinical and laboratory parameters were measured.

RESULTS

NAFLD patients with advanced fibrosis had significantly higher RPR than those without fibrosis (P < .001). Spearman correlation analysis showed that RPR were significantly correlated with age, sex, creatinine, hemoglobin, white blood cell, and advanced fibrosis (all with P < .05). Multivariate logistic regression analysis showed that RPR was an independent factor predicting advanced fibrosis (fibrosis-4 calculator ≥1.3) in NAFLD patients (OR: 5.718, 95%CI: 3.326-9.830, P < .001).

CONCLUSIONS

Our findings suggested that RPR were significantly associated with advanced fibrosis in nonalcoholic fatty liver disease patients.

Red blood cell distribution width is an independent risk factor in the prediction of acute respiratory distress syndrome after severe burns

BACKGROUND

The occurrence of acute respiratory distress syndrome (ARDS) significantly increases the mortality and morbidity of major burns; there are few laboratory markers that predict the development of ARDS in severe burns. This study was to investigate the relationship between complete blood count (CBC) parameters and the incidence of ARDS in severe burn patients.

METHODS

An eight-year retrospective study was performed on 610 severe burn patients who were admitted to the First Affiliated Hospital of Anhui Medical University and Rui Jin Hospital of Shanghai Jiao Tong University from January 2008 to December 2015. The patients were divided into two groups based on the development of ARDS. A blood sample was taken at admission and CBC parameters were examined. Univariate logistic regression analysis was used to evaluate the risk factors for the development of ARDS.

RESULTS

Of these 610 patients, 143 developed ARDS giving a rate of 23.44%. The percentage of deep second degree and full thickness burn, inhalation injury and red blood cell distribution width (RDW) were independently associated with the development of ARDS in severe burn patients. Every 1% increase in RDW was associated with a 29% increase in the risk to develop ARDS.

CONCLUSIONS

The findings of this study suggest that an elevated RDW is associated with an increased risk of ARDS and RDW is an independent risk factor in the prediction of ARDS after severe burns.