Elevated red cell distribution width opon ICU admission independently predicts mortality in young patients with sepsis-associated encephalopathy: A propensity score-matched retrospective cohort study using MIMIC-IV database-ZENTIME PUBLISHING CORPORATION LIMITED

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Elevated red cell distribution width opon ICU admission independently predicts mortality in young patients with sepsis-associated encephalopathy: A propensity score-matched retrospective cohort study using MIMIC-IV database

Yalin Zhu^1,2,*, Zhengyu Jiang^2,*, Wangzheqi Zhang^2,3,*, Jie Huang², Haoling Zhang⁴, Haiwen Wang¹, Jiafeng Wang^2,#, Wen Xu^1,#

¹Department of Anesthesiology, Naval Hospital of Eastern Theater, Zhoushan 316004, Zhejiang, China.

²Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China.

³School of Anesthesiology, Naval Medical University, Shanghai 200433, China.

⁴Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia.

^*The authors contribute equally.

^#The authors are co-corresponding authors.

Address correspondence to: Wen Xu, Department of Anesthesiology, Naval Hospital of Eastern Theater, No. 98, Wenhua Road, Dinghai District, Zhoushan 316004, Zhejiang, China. E-mail: xuwennhet@163.com. Jiafeng Wang, Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, No. 168, Changhai Road, Yangpu District, Shanghai 200433, China. E-mail: jfwang@smmu.edu.cn.

DOI: https://doi.org/10.61189/402108pvrojs

Received November 18, 2025; Accepted March 3, 2026; Published March 31, 2026

Highlights

● Elevated red cell distribution width (RDW) (>14.65%) at intensive care unit admission independently predicts 30-day mortality in young patients with sepsis-associated encephalopathy (SAE) (hazard ratio=2.7, 95% confidence interval [CI]: 1.4-5.3; P=0.003), persisting after rigorous propensity score matching (352 pairs) and multivariable adjustment.

● RDW achieved an area under the curve of 0.760 (95% CI: 0.720-0.800), outperforming prior reports in elderly sepsis cohorts and underscoring its specificity for young SAE.

● RDW is a low-cost, routinely available biomarker. Its integration into risk stratification could enable early intervention in resourcelimited settings, challenging the paradigm of youth conferring low risk in SAE.

Abstract

Background: Current prognostic research on sepsis-associated encephalopathy (SAE) predominantly focuses on elderly populations, while independent risk markers for young patients remain unclear. Objective: To investigate the prognostic value of red cell distribution width (RDW) for 30-day mortality in young SAE patients admitted to the intensive care unit (ICU). Methods: This retrospective cohort study analyzed 1,594 SAE patients (18-65 years) from the MIMIC-IV database. Using propensity score matching (1:1 nearest-neighbor matching), 352 matched pairs were generated. RDW-mortality association was assessed through restricted cubic splines, multivariable Cox regression, and Kaplan-Meier analysis. Results: Among the 1,594 young patients with SAE analyzed, 144 subjects (9.0%) passed away within 30 days following their ICU admission. Non-survivors exhibited significantly higher baseline RDW than survivors (17.5±3.1 versus 14.9±2.4, P<0.001). Patients exhibiting elevated RDW showed higher rates of hepatic disorders, clotting dysfunction, and impaired kidney function (all P<0.001). RDW and 30-day post-ICU admission mortality were nonlinearly related. After matching (standardized mean difference <0.1 for all covariates), higher RDW values showed a notable association with greater mortality risk over a 30-day period (hazard ratio [HR]=2.7, 95% confidence interval [CI]: 1.4-5.3, P=0.003). Also, after comprehensive adjustment for covariates, each 1-unit increase in RDW was still associated with a 20% rise in the risk of death (HR=1.2, 95% CI: 1.1-1.4, P<0.001). Kaplan-Meier curves confirmed reduced 30-day survival in high-RDW group (log-rank test, P=0.002). Conclusions: Elevated RDW at ICU admission independently predicts 30-day mortality in young SAE patients.

Keywords: Sepsis-associated encephalopathy, 30-day mortality in intensive care unit, Red cell distribution width, Predictor, Young patients, MIMIC-IV database

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