ArticlePloS one2025
Longitudinal modeling of red blood cell distribution width dynamics and mortality risk in critically Ill patients with sepsis-associated acute kidney injury.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Development and a single-centre temporal validation of a machine learning-based model for early prediction of acute pancreatitis-associated liver injury.BMC gastroenterology · 2026Article
- Association between hemoglobin-to-red blood cell distribution width ratio trajectory patterns and in-hospital mortality in critically ill patients with cirrhosis: a retrospective cohort study based on MIMIC-IV and eICU-CRD.BMC medical informatics and decision making · 2026Article
- Association between hemoglobin/red blood cell distribution width ratio and acute kidney injury in sepsis and heart failure patients.PloS one · 2026Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSepsis-associated acute kidney injury (SA-AKI) is a critical condition with high mortality. Red cell distribution width (RDW) has emerged as a potential dynamic biomarker, but longitudinal RDW changes in SA-AKI remain underexplored.
methodsThis retrospective cohort study analyzed adult SA-AKI patients from the MIMIC-IV database (2008-2022). Group-Based Trajectory Modeling (GBTM) identified distinct longitudinal RDW patterns. Primary outcome was 28-day all-cause mortality. Secondary outcomes included 90-day mortality, continuous renal replacement therapy (CRRT) requirement, and ICU length of stay. Multivariable Cox models assessed associations. adjustment for any transfusion and any major hemorrhage, and an exclusion analysis in which all transfused patients were removed.
resultsAmong 6,694 patients (mean age 65.5 years, 57.7% male), 28-day mortality was 22.5%. Four RDW trajectory groups were identified: Stable Low (27.8%), Gradual Increase (38.5%), Continuous Increase (27.6%), and Rapid Increase (6.1%). The Rapid Increase group demonstrated highest disease severity scores and poorest laboratory profiles. Compared to the Stable Low group, the Rapid Increase group had significantly elevated 28-day mortality risk after full adjustment (HR 4.27, P < 0.001), with consistent patterns for 90-day mortality and resource use. Associations remained consistent across subgroup analyses, multiple-imputation datasets, and the relaxed-inclusion cohort, and were minimally altered after adjusting for transfusion/hemorrhage or excluding transfused patients.
conclusionsDynamic RDW trajectories were independently associated with adverse outcomes in SA-AKI patients. Across extensive sensitivity analyses, these trajectories functioned as dynamic prognostic indicators without implying causality, supporting their use for risk stratification and individualized patient care.
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