Tang Shanshan, Zhang Zhiqiang, Wang Yulong, Li Yongle
Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.
Heliyon. 2024 Aug 3;10(16):e35796. doi: 10.1016/j.heliyon.2024.e35796. eCollection 2024 Aug 30.
The association between the red blood cell distribution width-platelet ratio (RPR) and mortality in heart failure patients remains unclear. We aimed to investigate the potential non-linear relationship between RPR and 1-year mortality risk. A retrospective cohort study was conducted involving 6982 participants from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Multivariable Cox regression and restricted cubic spline analyses were performed to evaluate the association between RPR and 1-year mortality, adjusting for potential confounders. We observed 1091 patients died in hospital and 2535 patients died during 1 year follow-up period. The prevalence or incidence of mortality did not show statistically significant differences among RPR groups in the overall study population. However, a positive association between RPR and the risk of mortality was noted after adjusting for multiple variables (HR = 1.38, 95 % CI = 1.06-1.81, = 0.018). Analysis using restricted cubic splines indicated a U-shaped relationship between RPR levels and the risk of mortality ( nonlinearity <0.05), with the point of lowest risk at 0.104. Compared to this level, lower RPR (<0.104) was associated with increased mortality (HR = 0.046, 95 % CI: 0.004-0.546), as was higher RPR (>0.104) (HR = 2.656, 95 % CI: 1.692-4.170).This U-shaped association was consistent across subgroup analyses (all interaction values > 0.05). RPR exhibits a U-shaped association with 1-year mortality in heart failure patients, suggesting both low and high RPR levels are linked to increased risk. RPR may serve as a relevant biomarker for risk stratification in this population. We incorporated RPR into the SOFA (AUC 0.731) and SAPS II (AUC 0.746) models, which significantly improved their predictive ability for in-hospital mortality. For 1-year mortality prediction, RPR + SAPS II (AUC 0.683) showed significantly improved accuracy, while RPR + SOFA (AUC 0.626) did not improve significantly.
红细胞分布宽度与血小板比值（RPR）和心力衰竭患者死亡率之间的关联尚不清楚。我们旨在研究RPR与1年死亡风险之间潜在的非线性关系。进行了一项回顾性队列研究，纳入了医学重症监护信息集市IV（MIMIC-IV）数据库中的6982名参与者。进行多变量Cox回归和限制性立方样条分析，以评估RPR与1年死亡率之间的关联，并对潜在混杂因素进行校正。我们观察到1091例患者在医院死亡，2535例患者在1年随访期内死亡。在整个研究人群中，RPR组之间的死亡率患病率或发病率没有统计学上的显著差异。然而，在对多个变量进行校正后，发现RPR与死亡风险呈正相关（HR = 1.38，95%CI = 1.06 - 1.81，P = 0.018）。使用限制性立方样条进行的分析表明，RPR水平与死亡风险之间呈U形关系（非线性P<0.05），风险最低点为0.104。与该水平相比，较低的RPR（<0.104）与死亡率增加相关（HR = 0.046，95%CI：0.004 - 0.546），较高的RPR（>0.104）也是如此（HR = 2.656，95%CI：1.692 - 4.170）。这种U形关联在亚组分析中是一致的（所有交互作用P值>0.05）。RPR与心力衰竭患者的1年死亡率呈U形关联，表明RPR水平过低和过高均与风险增加有关。RPR可能是该人群风险分层的相关生物标志物。我们将RPR纳入序贯器官衰竭评估（SOFA）模型（AUC 0.731）和简化急性生理学评分II（SAPS II）模型（AUC 0.746），这显著提高了它们对住院死亡率的预测能力。对于1年死亡率预测，RPR + SAPS II（AUC 0.683）显示准确性显著提高，而RPR + SOFA（AUC 0.626）没有显著改善。
