Immune Dysfunction-Associated Elevated RDW, APACHE-II, and SOFA Scores Were a Possible Cause of 28-Day Mortality in Sepsis Patients

Abstract

Objective

To explore the early predictors and their predicting value of 28-day mortality in sepsis patients and to investigate the possible causes of death.

Methods

127 sepsis patients were included, including 79 cases in the survival group and 48 cases in the death group. The results of all patients on admission were recorded. After screening the risk factors of 28-day mortality, the receiver operating characteristic curve (ROC) was used to determine their predictive value for the 28-day mortality rate on admission, and the Kaplan-Meier curve was drawn to compare the 28-day mortality rate between groups. Finally, patients with cytokine and lymphocyte subsets results were included for investigating the possible causes of death through correlation analysis.

Results

APACHE II (acute physiology and chronic health evaluation II), SOFA (Sequential Organ Failure Assessment) and red blood cell distribution width (RDW) were the risk factors for 28-day mortality in sepsis patients (OR: 1.130 vs.1.160 vs.1.530, P < 0.05). The area under the curve (AUC), sensitivity and specificity of APACHE II, SOFA and RDW in predicting the mortality rate at 28 days after admission in sepsis patients were 0.763 vs 0.806 vs 0.723, 79.2% vs 68.8% vs 75.0%, 65.8% vs 89.9% vs 68.4%. The combined predicted AUC was 0.873, the sensitivity was 89.6%, and the specificity was 82.3%. The Kaplan-Meier survival curve showed that the 28-day mortality rates of sepsis patients with APACHE II≥18.5, SOFA≥11.5 and RDW≥13.8 were 58.5%, 80.5% and 59.0%, respectively. In the death group, APACHE II was positively correlated with SOFA, IL-2, and IL-10, and RDW was positively correlated with PLT, TNF-α, CD3⁺ lymphocyte count, and CD8⁺ lymphocyte count.

Conclusion

Sepsis patients with high APACHE II, SOFA and RDW levels at admission have an increased 28-day mortality rate. The elevation of these indicators in dead patients are related to immune dysfunction.

Keywords:

• sepsis
• APACHE II
• SOFA
• red blood cell distribution width
• mortality
• immune dysfunction

Ethical Approval

The research related to human use has complied with all the relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the Ethics Committee of Taizhou Hospital in Zhejiang Province. As a retrospective study, this study only collected and analyzed clinical data of patients and did not affect the diagnosis and treatment process and outcomes of patients. Therefore, the Ethics Committee waived informed consent. Researchers will hide all identifiable patient information to avoid disclosing personal privacy.

Acknowledgments

We thank the medical staff of the ICU for the diagnosis and treatment of sepsis patients.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Jing Wang, Lisha He, and Zhiyan Jin contributed equally to this work and shared the first authorship.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by grants from the Medical Science and Technology Project of Zhejiang Province (2022KY1378, 2021KY1204) and the Scientific Research Foundation of Taizhou Enze Medical Center (Group) (21EZD15, 23EZB08). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.