Table 1_Association between red cell distribution width and 30-day mortality in patients with sepsis-associated liver injury: a retrospective cohort study.docx

BackgroundSepsis-associated liver injury (SALI) is a critical component of sepsis-induced multiple organ dysfunction with high mortality. Identifying biomarkers for risk stratification is essential. Red cell distribution width (RDW), indicating variation in red blood cell volume, has been linked to adverse outcomes in various diseases. This study aimed to evaluate the association between RDW and 30-day mortality in SALI patients.
MethodsA retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care-IV database. Patients admitted to the intensive care unit (ICU) with SALI were included. RDW was recorded within the initial 24 h. The primary outcome was 30-day mortality. A multivariable Cox regression analysis was performed to examine the relationship between RDW and mortality.
ResultsAmong 529 SALI patients (mean age 68.7 years, 61.8% male), 46.1% had RDW > 15.5%. The 30-day mortality rate was 35.5%. RDW was significantly higher in non-survivors compared to survivors (17.2 ± 3.0 vs. 15.4 ± 2.3, P < 0.001). Cox regression identified RDW as an independent risk factor for 30-day mortality (HR 1.14, 95% CI 1.09 to 1.19, P < 0.001). Subgroup analyses demonstrated that the findings were consistent across the various groups.
ConclusionElevated RDW is independently associated with higher 30-day mortality in patients with SALI, suggesting its potential role in risk stratification and clinical management.

背景：脓毒症相关性肝损伤（Sepsis-associated liver injury, SALI）是脓毒症诱导多器官功能障碍的重要组成部分，且病死率较高。明确用于风险分层的生物标志物具有重要临床意义。红细胞分布宽度（Red cell distribution width, RDW）可反映红细胞体积的异质性，目前已被证实与多种疾病的不良预后相关。本研究旨在评估脓毒症相关性肝损伤患者的红细胞分布宽度与30天病死率之间的关联。
方法：本研究采用回顾性队列研究设计，数据来源于重症医学信息库第四版（Medical Information Mart for Intensive Care-IV）数据库。纳入收治于重症监护病房（Intensive Care Unit, ICU）且确诊脓毒症相关性肝损伤的患者，采集其入科最初24小时内的红细胞分布宽度数据。本研究的主要结局指标为30天病死率，采用多变量Cox回归分析探讨红细胞分布宽度与患者病死率之间的关联。
结果：本研究共纳入529例脓毒症相关性肝损伤患者，平均年龄为68.7岁，男性占比61.8%；其中46.1%的患者红细胞分布宽度＞15.5%。整体患者30天病死率为35.5%。非存活组患者的红细胞分布宽度显著高于存活组（17.2±3.0 vs. 15.4±2.3，P＜0.001）。多变量Cox回归分析显示，红细胞分布宽度是患者30天病死率的独立危险因素（风险比（Hazard Ratio, HR）=1.14，95%置信区间（95% Confidence Interval, 95% CI）：1.09~1.19，P＜0.001）。亚组分析结果表明，各亚组间的研究结论均保持一致。
结论：脓毒症相关性肝损伤患者红细胞分布宽度升高与30天病死率升高呈独立相关，提示其在患者风险分层及临床诊疗管理中具有潜在应用价值。