The Ratio of Red Blood Cell Distribution Width to Albumin as a Predictor for Rehospitalization Risk and Rehospitalization All-Cause Mortality in Middle-Aged and Elderly Survivors with Sepsis: An Ambispective ICU Cohort Study

Abstract

Objective To explore the relationship between red blood cell distribution width to albumin (RDW/ALB) ratio (RAR) and the risk of rehospitalization and rehospitalization all-cause mortality in middle-aged and elderly survivors with sepsis based on an ambispective longitudinal cohort from the Intensive Care Unit (ICU). Methods Between 2017 and 2022, 455 adults who survived the first-episode severe sepsis without recurrence for at least 3 months were included in this study. All participants were followed up every 4 weeks for 12 months. According to the tertiles of RAR, participants were divided into three groups: low-level (≤0.36, n = 152), moderate-level (0.37–0.44, n = 152), and high-level (≥0.45, n = 151). The relationship between RAR and the risk of rehospitalization and rehospitalization all-cause mortality was evaluated. Results Out of 455 participants, 156 experienced rehospitalization (34.3%), of which 44 (28.2%) died. Receiver operating characteristic (ROC) analysis showed that the RAR cut-off values for rehospitalization and rehospitalization all-cause mortality were 0.4251 and 0.4743, respectively. Multivariate Cox regression analysis indicated that the RAR was positively associated with rehospitalization ( P = 0.011) and all-cause mortality ( P = 0.006). Compared with the low-level, the high-level RAR presented a higher dose-dependent rehospitalization risk ( P = 0.02) and rehospitalization all-cause mortality ( P = 0.044). The stratified analysis displayed that compared to the low-level, with the RAR increasing by 1.0, the risk for rehospitalization increased 3.602-fold in aged <65 patients ( P = 0.002) and 1.721-fold in female patients ( P = 0.014). Kaplan–Meier survival analysis implied a significant positive association between the RAR and the cumulative incidence of rehospitalization and rehospitalization all-cause mortality (log-rank, all P < 0.001). Conclusion RAR has a reliable predictive value for the risk of rehospitalization and rehospitalization all-cause mortality in patients with sepsis. Consequently, monitoring RAR for at least 1 year after surviving sepsis in female patients aged <65 in clinical practice is critical.

Follow-up study to explore the relationship between Neutrophil to lymphocyte ratio and impaired fasting glucose—using the group-based trajectory modeling

“…An elevated NLR may activate inflammatory pathways and cascades by activating corresponding receptors and blocking insulin receptor signaling, consequently leading to insulin resistance and T2DM 30 . The widely accepted theory about chronic inflammation and diabetes is that the JNK/IKK NF-κB pathway is activated, and both JNK and IKK are thought to be the mediators of insulin resistance induced by inflammation 31 – 33 . They exert their action by phosphorylating the serine residues on insulin receptor substrates (IRS) proteins, thereby blocking the phosphorylation of IRS on tyrosine residues subsequent to activation by the insulin receptor 34 .…”