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      The Association of Red Blood Cell Distribution Width to Platelet Count Ratio and 28-Day Mortality of Patients with Sepsis: A Retrospective Cohort Study

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          Abstract

          Background

          Sepsis is a life-threatening and inflammatory disease with high morbidity and mortality. Red blood cell distribution width to platelet count ratio (RPR) was known as an inflammatory biomarker and was related to poor outcomes of various diseases.

          Aim

          This study was intended to explore the association between RPR and mortality of sepsis patients.

          Methods

          A retrospective cohort study was undertaken in patients with sepsis, and the data were collected from a public database called Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was 28-day mortality while the secondary outcomes were 90-day mortality and ICU mortality. Multivariable regression analyses, as well as interaction and stratified analyses, were conducted to investigate the relation between RPR and sepsis mortality.

          Results

          In total, we enrolled 7531 patients with 1316 deaths. RPR was independently correlated with 28-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.02–1.06), 90-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.03–1.06) and ICU mortality (per 0.1 increase: OR=1.06; 95% CI 1.02–1.10). Twenty-eight-day survival was worse in the high RPR (≥0.134) group according to the Kaplan–Meier curve analyses (Log rank test, p<0.001). In stratified analyses, Sequential Organ Failure Assessment (SOFA) score and length of ICU stay had interactive effects with the high RPR (≥0.134) group on 28-day mortality.

          Conclusion

          RPR is a novel biomarker that indicates poor prognosis of sepsis patients. Clinicians are required to pay more attention to those patients with high RPR.

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          Most cited references 34

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          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
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            Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study

            Summary Background Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. Methods We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990–2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. Findings In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9–62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1–12·0) sepsis-related deaths were reported, representing 19·7% (18·2–21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8–54·5) and mortality decreased by 52·8% (47·7–57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. Interpretation Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. Funding The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.
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              MIMIC-III, a freely accessible critical care database

              MIMIC-III (‘Medical Information Mart for Intensive Care’) is a large, single-center database comprising information relating to patients admitted to critical care units at a large tertiary care hospital. Data includes vital signs, medications, laboratory measurements, observations and notes charted by care providers, fluid balance, procedure codes, diagnostic codes, imaging reports, hospital length of stay, survival data, and more. The database supports applications including academic and industrial research, quality improvement initiatives, and higher education coursework.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                tcrm
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                19 October 2020
                2020
                : 16
                : 999-1006
                Affiliations
                [1 ]Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Institute of Pulmonary Diseases, Sun Yat-sen University , Guangzhou, Guangdong, People’s Republic of China
                Author notes
                Correspondence: Mian Zeng Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University , No. 58 Zhongshan Road 2, Guangzhou, Guangdong510080, People’s Republic of China Email zengmian@mail.sysu.edu.cn
                Article
                268523
                10.2147/TCRM.S268523
                7586012
                33116549
                © 2020 Ge et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 11, References: 34, Pages: 8
                Funding
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                The study was supported by National Natural Science Foundation of China (Grant number 81670066); Guangdong Basic and Applied Basic Research Foundation (Grant number 2019A1515011198); Major Science and Technology Planning Project of Guangdong Province, China (Grant number 2016A020216009); and Critical Care Research Funding of the Aesculap Academy (2017).
                Categories
                Original Research

                Medicine

                mimic-iii, inflammatory marker, prognosis, sepsis, icu

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