脓毒症相关性谵妄患者红细胞分布宽度与白蛋白比值和短期死亡率之间的关联：一项来自MIMIC-IV数据库的回顾性研究

Association between red cell distribution width-to-albumin ratio and short-term mortality in patients with sepsis-associated delirium: a retrospective study from the MIMIC-IV database.

作者信息

Yao ShengJie, Zhang Guofen, Ni Lifeng

机构信息

Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China.

出版信息

BMC Anesthesiol. 2025 Apr 21;25(1):192. doi: 10.1186/s12871-025-03061-7.

BACKGROUND

Sepsis-associated delirium (SAD) is a common and severe acute neuropsychiatric manifestation in patients with sepsis, which is associated with increased mortality and lasting cognitive deficits. The red cell distribution width to albumin ratio (RAR) has been recognized as a robust prognostic indicator for adverse outcomes across various diseases. This study aims to investigate the relationship between RAR and short-term mortality in patients with SAD after admission to the intensive care unit (ICU).

METHODS

This retrospective cohort study leveraged the MIMIC-IV 3.1 database to analyze the primary outcome of all-cause mortality within 30 days of ICU admission for patients with SAD. According to the receiver operating characteristic(ROC) curve to determine the optimal cut-off point of RAR, SAD patients were divided into low RAR group (RAR < 5.85) and high RAR group (RAR ≧ 5.85). To mitigate potential confounding factors, a 1:1 propensity score matching (PSM) method was implemented. The relationship between RAR and short-term mortality was further assessed using multivariate Cox proportional hazards regression models and Kaplan-Meier (KM) survival curve analyses.

RESULTS

The study included 4021 patients with SAD. After PSM, 1063 score-matched pairs of patients were generated. Cox proportional hazards models were adjusted for potential confounders, Patients with elevated RAR (≥ 5.85) exhibited a significantly higher 30-day mortality rate compared to those with a lower RAR (< 5.85), with a hazard ratio (HR) of 1.53 (95% CI: 1.35-1.75, P < 0.001). Propensity scores matching analysis corroborated these results, consistently indicating a higher mortality rate in the high RAR group, with an HR of 1.39 (95% CI: 1.19-1.61, P < 0.001).

CONCLUSIONS

An Elevated RAR upon ICU admission was independently associated with an increased risk of short-term mortality in patients with SAD.

背景

脓毒症相关性谵妄（SAD）是脓毒症患者常见且严重的急性神经精神症状，与死亡率增加及持续的认知缺陷相关。红细胞分布宽度与白蛋白比值（RAR）已被认为是多种疾病不良预后的可靠预测指标。本研究旨在探讨RAR与重症监护病房（ICU）收治的SAD患者短期死亡率之间的关系。

方法

这项回顾性队列研究利用MIMIC-IV 3.1数据库分析SAD患者入住ICU后30天内全因死亡率这一主要结局。根据受试者工作特征（ROC）曲线确定RAR的最佳截断点，将SAD患者分为低RAR组（RAR＜5.85）和高RAR组（RAR≥5.85）。为减轻潜在混杂因素的影响，采用1:1倾向评分匹配（PSM）方法。使用多变量Cox比例风险回归模型和Kaplan-Meier（KM）生存曲线分析进一步评估RAR与短期死亡率之间的关系。

结果

该研究纳入4021例SAD患者。PSM后，生成了1063对评分匹配的患者。Cox比例风险模型针对潜在混杂因素进行了调整，RAR升高（≥5.85）的患者与RAR较低（＜5.85）的患者相比，30天死亡率显著更高，风险比（HR）为1.53（95%CI：1.35 - 1.75，P＜0.001）。倾向评分匹配分析证实了这些结果，始终表明高RAR组死亡率更高，HR为1.