# Early increase in red cell distribution width-to-platelet ratio is associated with poor prognosis in sepsis patients: a retrospective cohort study

## TL;DR

Early increases in red cell distribution width-to-platelet ratio (RPR) in sepsis patients are linked to higher mortality risk, suggesting RPR could help predict outcomes.

## Contribution

This study reveals that dynamic changes in RPR during the first 6 days of ICU admission are novel predictors of sepsis prognosis.

## Key findings

- Non-survivors showed a pronounced early increase in RPR compared to survivors.
- Scaled RPR differences widened at 1.75 units per day between survivors and non-survivors.
- Longitudinal RPR trends may improve risk stratification in sepsis patients.

## Abstract

Previous studies have reported associations between baseline red cell distribution width-to-platelet ratio (RPR) and outcomes in sepsis patients. However, whether dynamic changes in RPR over time influence prognosis in sepsis remains unclear. This study aimed to investigate the significance of RPR trajectories during the progression of sepsis.

This retrospective cohort study included sepsis patients admitted to the ICU from January 2014 to December 2015, using data extracted from the eICU Collaborative Research Database. Demographics, comorbidities, laboratory results, and clinical outcomes were collected. A generalized additive mixed model (GAMM) was employed to compare longitudinal trends in RPR between survivors and non-survivors, adjusting for potential confounders.

A total of 2,226 patients were included, with 328 deaths within 28 days of hospitalization. Scaled RPR exhibited divergent temporal patterns between survivors and non-survivors. In the first 6 days of ICU admission, scaled RPR gradually decreased and stabilized in survivors, whereas non-survivors showed a pronounced early increase. After adjusting for multiple covariates, this dynamic trend remained significant. The difference in scaled RPR between survivors and non-survivors widened at an average rate of 1.75 units per day.

During the early stage of ICU admission (0–6 days), RPR may serve as a dynamic biomarker reflecting evolving pathophysiological changes. Early increases in RPR were observed to be associated with a higher risk of in-hospital mortality. These findings suggest that longitudinal RPR trajectories may provide supplementary information regarding risk stratification and warrant further investigation in conjunction with established clinical assessments.