The association between RDW-to-platelet ratio and in-hospital mortality in critically ill stroke patients: A retrospective cohort study based on the eICU database

Clinical Snapshot

Key Findings

• P Value: P < 0.001

• Effect Size: Adjusted OR = 1.046 per unit increase in RPR

• Primary Outcome: In-hospital mortality: 17.7% in high RPR vs 11.6% in low RPR groups

• Nnt Or Sensitivity: 4.6% increased odds of death per unit RPR increase; APACHE-IV mediated 20.15% of total effect

• Confidence Interval: 95% CI: 1.032-1.061

Clinical Application

High - RPR calculated from routine blood tests (RDW and platelet count) available in all Australian ICUs Relevant to Australian ICUs; RPR components are standard pathology tests covered by Medicare. Could complement existing stroke severity assessments in line with Stroke Foundation guidelines Critically ill stroke patients in intensive care settings

Abstract

OBJECTIVE: The red cell distribution width-to-platelet ratio (RDW-to-platelet ratio, RPR) is a potential biomarker of inflammation and bone marrow function. This study aimed to investigate the association between RPR and in-hospital mortality in critically ill stroke patients in the eICU, and to evaluate mediating role of APACHE-IV score. METHOD: This retrospective cohort study utilized data from the 2014-2015 US multicenter eICU database. Of 200,859 initially included patients, 9,736 critically ill stroke patients were analyzed after excluding non-stroke cases and those with missing key variables. Multivariable logistic regression assessed the relationship between RPR and in-hospital mortality, adjusting for age, sex, comorbidities, and laboratory parameters, with multiple imputation for missing data. Subgroup analyses, mediation analysis, and restricted cubic spline modeling were performed. RESULTS: Patients with higher RPR exhibited significantly elevated in-hospital mortality (17.7% vs. 11.6%, P < 0.001). After adjustment, each unit increase in RPR was associated with 4.6% higher odds of death (adjusted OR=1.046, 95% CI: 1.032-1.061, P < 0.001), with consistent findings across subgroups. Restricted cubic spline analysis indicated a linear relationship. Mediation analysis showed that APACHE-IV score mediated 20.15% of the total effect (P < 0.001). CONCLUSIONS: Elevated RPR is independently associated in-hospital mortality in critically ill stroke patients, partly mediated by disease severity. As a simple and accessible marker, RPR shows promise for clinical prognostic risk stratification.

References

1. 1.Chen, Y., Yang, X., Lan, M., Qin, X., Yi, D., & Chen, L. (2026). The association between RDW-to-platelet ratio and in-hospital mortality in critically ill stroke patients: A retrospective cohort study based on the eICU database. PLoS One. https://doi.org/10.1371/journal.pone.0344361