通讯作者: 麻贤辉, maxh@enzemed.com

DOI：10.12201/bmr.202509.00026

The efficacy study of the ratio of red blood cell distribution width to platelet count in the early diagnosis of sepsis induced coagulation disease

• 摘要：目的：评估红细胞分布宽度与血小板计数比值（RPR）在脓毒症性凝血病（SIC）早期预警中的价值。方法：基于美国重症监护医学信息数据库－IV 3.1(MIMIC－IV 3.1)，纳入首次入院且首次入住重症监护室（intensive care unit，ICU）且年龄≥18岁的脓毒症患者4347例。按国际血栓与止血学会（international society on thrombosis and haemostasis，ISTH）推荐的SIC评分≥4分分为SIC组（n=2309例）与非SIC组（n=2038例）。采集基本信息、合并症、机械通气及血管活性药物的使用情况、序贯器官衰竭评分(Sepsis-related Organ Failure Score，SOFA评分）；入ICU首次实验室指标：血常规、静脉血生化、血气分析、凝血谱；临床预后：ICU 28天死亡率。采用多因素Logistic回归和受试者工作曲线（receiver operator characteristic curve，ROC曲线）分析RPR的诊断效能。结果：与非SIC组相比，SIC组年龄更大，合并心衰/心梗、慢性肾病及血管活性药物使用率更高，SOFA评分、红细胞分布宽度（red blood cell distribution width，RDW）、RPR、肝肾功能、乳酸、凝血酶原时间（prothrombin time，PT）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT），国际标准化比值（international normalized ratio，INR）均升高；高血压比例、血红蛋白、血小板、白蛋白、生化钙、酸碱度(Pondus Hydrogenii，pH），纤维蛋白原（fibrinogen，FIB）降低（均P＜0.05）。28天ICU死亡率显著高于非SIC组。多因素Logistic回归分析发现RPR为SIC独立危险因素，其AUC值为0.808，最佳截断值为0.095，INR的AUC值为0.915，最佳截断值为1.41；RPR联合INR的AUC值为0.988。结论：SIC组的ICU 28天死亡率较非SIC组高，RPR是发生SIC的独立危险因素，与INR联合可显著提升早期诊断准确性，值得临床重点关注。

  关键词： 红细胞分布宽度与血小板计数比值；脓毒症；脓毒症性凝血病；早期预警; ; 

   

  Abstract: Objective: To evaluate the value of red blood cell distribution width/platelet count ratio (RPR) in early warning of septic coagulation disease (SIC). Method: Based on the US Intensive Care Medicine Information Database - IV 3.1 (MIMIC-IV 3.1), 4347 patients with sepsis who were admitted for the first time and had their first stay in the intensive care unit (ICU) and were aged 18 years or older were included.According to the International Society on Thrombosis and Hemostasis (ISTH) recommended SIC score of ≥ 4, patients were divided into SIC group (n=2309) and non SIC group (n=2038). Collect basic information, comorbidities, use of mechanical ventilation and vasoactive drugs, and Sequential Organ Failure Score (SOFA score); Initial laboratory indicators upon admission to the ICU: blood routine, venous blood biochemistry, blood gas analysis, coagulation spectrum; Clinical prognosis: ICU 28 day mortality rate. Use multiple logistic regression and receiver operator characteristic curve (ROC curve) to analyze the diagnostic efficacy of RPR. Result: Compared with the non-SIC group,the SIC group was older and had higher rates of heart failure/myocardial infarction, chronic kidney disease, and vasoactive drug use. SOFA score, red blood cell distribution width RPR、 Liver and kidney function, lactate, prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR) all increased; The proportion of hypertension, hemoglobin, platelets, albumin, biochemical calcium, Pondus Hydrogeni (pH), and fibrinogen (FIB) decreased (all P<0.05). The 28 day ICU mortality rate was significantly higher than that of the non SIC group. Multivariate logistic regression analysis revealed that RPR is an independent risk factor for SIC, with an AUC value of 0.808 and an optimal cutoff value of 0.095. The AUC value for INR is 0.915 and the optimal cutoff value is 1.41; The AUC value of RPR combined with INR is 0.988. Conclusion: The ICU 28 day mortality rate in the SIC group is higher than that in the non SIC group. RPR is an independent risk factor for the occurrence of SIC, and its combination with INR can significantly improve early diagnostic accuracy, which deserves clinical attention.

  Key words: ratio of red blood cell distribution width to platelet count; Sepsis; Sepsis-induced coagulopathy；Early warning

  提交时间：2025-09-10

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• 序号	提交日期	编号	操作
  1	2025-08-06	bmr.202509.00026V1	下载

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