Association Between Hemoglobin-To-Red Cell Distribution Width Ratio and Mortality Risk in Sepsis-Induced Coagulopathy: A Retrospective Study Based on MIMIC-IV Database.

BackgroundSepsis-induced coagulopathy (SIC) is an early stage of disseminated intravascular coagulation (DIC) and is associated with adverse clinical outcomes. The hemoglobin-to-red cell distribution width ratio (HRR) is a novel biomarker that has been found to have predictive value in various diseases. However, its prognostic significance in patients with SIC remains unclear.MethodsThis retrospective cohort study used the MIMIC-IV database and included ICU patients meeting the Sepsis-3 and SIC criteria. Clinical data within 24 hours of ICU admission were collected to calculate HRR, and patients were categorized into quartiles according to it (Q1: <0.56; Q2: 0.56-0.69; Q3: 0.69-0.82; Q4: ≥0.82). Associations between HRR and 28-, 90- and 365-day all-cause mortality were evaluated using restricted cubic splines, Kaplan-Meier curves, Cox proportional hazards models, and receiver operating characteristic curves. Subgroup and interaction analyses were performed to assess robustness and potential effect modification.ResultsA total of 5,279 patients with SIC were included in the study. After multivariate adjustment, the lowest HRR quartile was significantly associated with elevated 28-day mortality risk (HR = 1.36, 95% CI: 1.18-1.53, P < 0.001), suggesting that lower HRR levels were linked to higher mortality. This association remained consistent across different time points and was robust in subgroup analyses.ConclusionsHRR demonstrated a significant non-linear association with all-cause mortality in patients with SIC, with lower levels indicating a higher risk of death. As a readily available hematological marker, HRR may serve as a practical tool for the early risk assessment in this population.