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The relationship between red cell distribution width and platelet ratio in acute kidney injury among ventilator-associated pneumonia patients: A MIMIC-IV database study 

Ye Song, Minling Li, AQiao Sun, and Huan Liang

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Volume 106 (2026) p. 198 - 207

Abstract

Clinical Nephrology, Vol. 106 – No. 3/2026 (198-207)

The relationship between red cell distribution width and platelet ratio in acute kidney injury among ventilator-associated pneumonia patients: A MIMIC-IV database study 

Ye Song, Minling Li, AQiao Sun, and Huan Liang

Emergency Department of The First Affiliated Hospital of Xi’an Jiao Tong University, Xi ‘an, Shaanxi, China
Background: Acute kidney injury (AKI) is a common sequela of ventilator-associated pneumonia (VAP), further complicating patient care and outcomes. The red cell distribution width-to-platelet ratio (RPR), an established marker of inflammation, may be linked to the development of AKI in VAP patients.
Purpose: The study aimed to examine the connection between RPR and the incidence of AKI in VAP patients.
Materials and methods: This study utilized data from the Medical Intensive Care Database. Logistic regression was applied to investigate the connection between RPR and AKI prevalence in VAP patients. Restricted cubic splines were used to determine if the relationship was non-linear, and subgroup analyses were conducted. The predictive performance of the scoring tool, with RPR included, was evaluated using integrated discrimination improvement and net reclassification index calculations.
Results: Our study included 1,547 VAP patients, of whom 1,070 had AKI. Logistic regression analysis demonstrated that higher log (RPR × 1,000) values were significantly associated with increased AKI prevalence in VAP patients (OR = 1.741, 95% CI: 1.124 – 2.738, p = 0.014). The highest tertile group had a significantly higher AKI prevalence compared to the lowest tertile group (OR = 2.333, 95% CI: 1.259 – 4.447, p = 0.008). Our analysis found no evidence of non-linear associations or significant interactions among subgroups. The predictive performance of the scoring tool was enhanced when RPR was incorporated.
Conclusion: Our analysis revealed that RPR is associated with higher AKI incidence in VAP patients. This discovery provides a new tool for early detection of patients at high risk for VAP-related AKI.Correspondence to:
Huan Liang
Emergency Center
The First Affiliated Hospital of Xi ‘an Jiaotong University
No. 277 West Yanta Road
Xi ‘an, 710061, Shaanxi, China
Email: [email protected]

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