内科

目的探讨入院时红细胞分布宽度与血小板计数比值（RPR）对成人脓毒症患者短期预后的预测价值。方法采用回顾性队列研究设计，连续纳入2021年1月至2023年12月广东省惠州市第六人民医院重症监护病房（ICU）收治的符合Sepsis 3.0诊断标准的成人脓毒症患者。根据入住ICU 28 d预后将患者分为生存组与死亡组。收集两组患者入院24 h内的临床资料，采用多因素logistic回归分析筛选28 d内死亡的独立预测因素，并通过受试者工作特征（ROC）曲线评估RPR及传统危重评分［序贯器官衰竭评估（SOFA）、急性生理学与慢性健康状况评估Ⅱ（APACHEⅡ）评分］的预测价值。结果共纳入132例患者，28 d内死亡37例（28.0%）。与生存组（n=95）相比，死亡组（n=37）患者年龄更高，RPR、SOFA评分及APACHEⅡ评分更高，血小板计数更低（均P<0.05）。多因素logistic回归分析显示，在调整年龄与病情严重程度后，RPR仍是28 d内死亡的独立预测因素（OR=6.18， 95%CI： 1.72～22.10， P=0.006）。ROC曲线分析显示，RPR预测28 d内死亡的曲线下面积（AUC）为0.75（95%CI： 0.73～0.89），与SOFA评分（AUC=0.76）和APACHEⅡ评分（AUC=0.73）相近。当RPR截断值为0.12时，其敏感度为83.8%，特异度为72.6%。结论入院RPR是成人脓毒症患者短期预后的独立预测因素，其预测价值与传统危重评分相当。RPR或可作为ICU中脓毒症患者早期风险分层的有效辅助工具。

Objective To explore the predictive value of the red blood cell distribution width to platelet count ratio (RPR) at admission for the short-term prognosis of adult patients with sepsis. Methods A retrospective cohort study design was adopted, and adult patients with sepsis who met the Sepsis 3.0 diagnostic criteria and were admitted to the intensive care unit of The Sixth People's Hospital of Huizhou in Guangdong Province from January 2021 to December 2023 were consecutively enrolled. Patients were divided into the survival group or the death group according to their 28-day prognosis after ICU admission. Clinical data of the two groups within 24 hours of admission were collected. Multivariate logistic regression analysis was used to screen for independent predictors of death within 28 days, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of RPR and traditional criticalillness scores （Sequential Organ Failure Assessment [SOFA] score, Acute Physiology and Chronic Health Evaluation Ⅱ [APACHE Ⅱ] score）. Results A total of 132 patients were included, with 37 cases (28.0%) dying within 28 days. Compared with the survival group (n=95), patients in the death group (n=37) were older, had higher RPR, SOFA score, and APACHE Ⅱ score, and lower platelet counts (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for age and disease severity, RPR remained an independent predictor of death within 28 days (OR=6.18, 95% CI: 1.72-22.10, P=0.006). ROC curve analysis showed that the area under the curve (AUC) of RPR for predicting death within 28 days was 0.75 (95% CI: 0.73-0.89), which was similar to that of the SOFA score (AUC=0.76) and APACHE Ⅱ score (AUC=0.73). When the cut-off value of RPR was 0.12, its sensitivity was 83.8% and specificity was 72.6%. Conclusion RPR at admission is an independent predictor of short-term prognosis in adult sepsis patients, and its predictive value is comparable to that of traditional critical illness scores. RPR may serve as an effective auxiliary tool for early risk stratification of sepsis patients in the ICU.