{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:31:56Z","timestamp":1764959516775,"version":"3.46.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical Key Specialty Program of Shanxi Bethune Hospital","award":["21002013601002"],"award-info":[{"award-number":["21002013601002"]}]},{"name":"Research Projects of the High-Quality Development Scientific Research Special Fund for the Health Industry in Shanxi Province","award":["DJKZXKT2023106"],"award-info":[{"award-number":["DJKZXKT2023106"]}]},{"name":"Sanjin Talent Project for Outstanding Young Talents in the Medical and Health Field","award":["SJYC2024457"],"award-info":[{"award-number":["SJYC2024457"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis after emergency gastrointestinal perforation surgery increases costs and hospital stay. Early diagnosis and management are vital. This study assesses the prognostic value of the red blood cell to platelet ratio (RPR) in these patients with abdominal sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Clinical data from MIMIC-IV and a hospital validation set were retrospectively analyzed. Demographics, comorbidities, and lab indices were extracted; missing values were imputed using random forest. RPR\u2019s dynamic changes and relation to prognosis were analyzed using latent category trajectory modeling. Prognostic factors were screened via Lasso-Cox regression to build column-line graph models. Kaplan-Meier, log-rank tests, and restricted cubic splines analyzed RPR-outcome associations. R 4.2.3 was used; P\u2009&lt;\u20090.05 was significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 243 patients were enrolled in MIMIC-IV and 253 patients were enrolled in the hospital. RPR was a significant prognostic indicator. Elevated RPR correlated with coagulation dysfunction (increased PT\/INR, decreased fibrinogen) and higher mortality risk. Trajectory analysis identified two RPR patterns; Class 1 had significantly lower 28-day mortality than Class 2. The hospitalization and ICU prognostic models demonstrated good efficacy. Validation set results supported these findings, indicating dynamic RPR changes effectively assess prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The red blood cell to platelet ratio may serve as a novel prognostic biomarker for abdominal septic patients, influencing clotting and kidney function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337480","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:27:02Z","timestamp":1764959222000},"page":"e0337480","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Red blood cell to platelet ratio and its trajectory as prognostic factors for patients with gastrointestinal tract perforation and abdominal sepsis"],"prefix":"10.1371","volume":"20","author":[{"given":"Jie","family":"Zhao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junkun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jixiu","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heihei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weidong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-3990","authenticated-orcid":true,"given":"Jifang","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"pone.0337480.ref001","first-page":"301","article-title":"History of global food safety, foodborne illness, and risk assessment","volume-title":"History of Food and Nutrition Toxicology","author":"BM Liu","year":"2023"},{"issue":"1","key":"pone.0337480.ref002","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41572-023-00431-8","article-title":"Helicobacter pylori infection","volume":"9","author":"P Malfertheiner","year":"2023","journal-title":"Nat Rev Dis Primers"},{"issue":"654","key":"pone.0337480.ref003","article-title":"A semaphorin-plexin-Rasal1 signaling pathway inhibits gastrin expression and protects against peptic ulcers","volume":"14","author":"R Xu","year":"2022","journal-title":"Sci Transl Med"},{"issue":"1","key":"pone.0337480.ref004","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13244-019-0823-6","article-title":"Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology","volume":"11","author":"S Pouli","year":"2020","journal-title":"Insights Imaging"},{"issue":"4","key":"pone.0337480.ref005","doi-asserted-by":"crossref","first-page":"120","DOI":"10.2478\/jccm-2018-0023","article-title":"Abdominal Sepsis: An Update","volume":"4","author":"MG Mure\u0219an","year":"2018","journal-title":"J Crit Care Med (Targu Mures)"},{"issue":"1","key":"pone.0337480.ref006","first-page":"20","article-title":"Perforation of the gastrointestinal tract and peritonitis in the neonate","volume":"160","author":"MJ Bell","year":"1985","journal-title":"Surg Gynecol Obstet"},{"issue":"3","key":"pone.0337480.ref007","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s00134-006-0504-z","article-title":"Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study","volume":"33","author":"S Karlsson","year":"2007","journal-title":"Intensive Care Med"},{"issue":"4","key":"pone.0337480.ref008","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1111\/j.1440-1746.2006.04500.x","article-title":"Factors affecting mortality and morbidity in patients with peptic ulcer perforation","volume":"22","author":"B Kocer","year":"2007","journal-title":"J Gastroenterol Hepatol"},{"issue":"3","key":"pone.0337480.ref009","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1177\/145749690409300306","article-title":"Severe secondary peritonitis following gastrointestinal tract perforation","volume":"93","author":"K Mulari","year":"2004","journal-title":"Scand J Surg"},{"issue":"2","key":"pone.0337480.ref010","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s00068-017-0777-7","article-title":"Preoperative factors influencing mortality and morbidity in peptic ulcer perforation","volume":"44","author":"P Sivaram","year":"2018","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"8","key":"pone.0337480.ref011","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.3748\/wjg.v25.i8.1024","article-title":"Establishing a model to measure and predict the quality of gastrointestinal endoscopy","volume":"25","author":"L-W Wang","year":"2019","journal-title":"World J Gastroenterol"},{"issue":"6","key":"pone.0337480.ref012","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1097\/00000658-199706000-00012","article-title":"Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection","volume":"225","author":"DJ Wickel","year":"1997","journal-title":"Ann Surg"},{"key":"pone.0337480.ref013","doi-asserted-by":"crossref","first-page":"3888","DOI":"10.12659\/MSM.907922","article-title":"Systemic Inflammatory Response Syndrome (SIRS) and the Pattern and Risk of Sepsis Following Gastrointestinal Perforation","volume":"24","author":"Z Ye-Ting","year":"2018","journal-title":"Med Sci Monit"},{"issue":"2","key":"pone.0337480.ref014","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s00423-004-0463-1","article-title":"Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis","volume":"389","author":"B Rau","year":"2004","journal-title":"Langenbecks Arch Surg"},{"issue":"3","key":"pone.0337480.ref015","doi-asserted-by":"crossref","DOI":"10.1128\/asmcr.00060-24","article-title":"Identification and characterization of an invasive, hyper-aerotolerant Campylobacter jejuni strain causing bacteremia in a pediatric leukemia patient","volume":"1","author":"X Zeng","year":"2025","journal-title":"ASM Case Rep"},{"issue":"4","key":"pone.0337480.ref016","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/CCM.0000000000002924","article-title":"Culture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study","volume":"46","author":"S Kethireddy","year":"2018","journal-title":"Crit Care Med"},{"issue":"1","key":"pone.0337480.ref017","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1186\/s13054-021-03592-8","article-title":"Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis","volume":"25","author":"Y Li","year":"2021","journal-title":"Crit Care"},{"issue":"31","key":"pone.0337480.ref018","doi-asserted-by":"crossref","first-page":"17040","DOI":"10.1021\/acs.analchem.5c02762","article-title":"Metabolism-Driven Colorimetric \u201cRead-to-Answer\u201d Sensor Array for Bacterial Discrimination and Antimicrobial Susceptibility Testing","volume":"97","author":"X Lin","year":"2025","journal-title":"Anal Chem"},{"issue":"1","key":"pone.0337480.ref019","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s41581-019-0199-3","article-title":"Prognostic and predictive enrichment in sepsis","volume":"16","author":"NL Stanski","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"9","key":"pone.0337480.ref020","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.3390\/ijms18091932","article-title":"The Effect of Sepsis on the Erythrocyte","volume":"18","author":"RM Bateman","year":"2017","journal-title":"Int J Mol Sci"},{"issue":"6","key":"pone.0337480.ref021","doi-asserted-by":"crossref","DOI":"10.1152\/ajpheart.01069.2002","article-title":"Appearance of an erythrocyte population with decreased deformability and hemoglobin content following sepsis","volume":"284","author":"MR Condon","year":"2003","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"3","key":"pone.0337480.ref022","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00109-006-0123-8","article-title":"Suicidal erythrocyte death in sepsis","volume":"85","author":"DS Kempe","year":"2007","journal-title":"J Mol Med (Berl)"},{"issue":"19","key":"pone.0337480.ref023","doi-asserted-by":"crossref","DOI":"10.3390\/ijms221910330","article-title":"Platelet inhibition prevents NLRP3 inflammasome activation and sepsis-induced kidney injury","volume":"22","author":"M Borges-Rodriguez","year":"2021","journal-title":"Int J Mol Sci"},{"key":"pone.0337480.ref024","doi-asserted-by":"crossref","first-page":"1210219","DOI":"10.3389\/fimmu.2023.1210219","article-title":"Sepsis - it is all about the platelets","volume":"14","author":"D Cox","year":"2023","journal-title":"Front Immunol"},{"key":"pone.0337480.ref025","article-title":"Platelet-to-red blood cell ratio and mortality in bleeding trauma patients: A systematic review and meta-analysis","author":"DJB Kleinveld","year":"2021","journal-title":"Transfusion"},{"issue":"1","key":"pone.0337480.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset","volume":"10","author":"AEW Johnson","year":"2023","journal-title":"Sci Data"},{"key":"pone.0337480.ref027","doi-asserted-by":"crossref","DOI":"10.1093\/ndt\/gfw380","article-title":"Identifying subgroups of renal function trajectories","volume":"32","author":"J Boucquemont","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0337480.ref028","doi-asserted-by":"crossref","first-page":"1283705","DOI":"10.3389\/fepid.2023.1283705","article-title":"Greedy knot selection algorithm for restricted cubic spline regression","volume":"3","author":"JI Arnes","year":"2023","journal-title":"Front Epidemiol"},{"key":"pone.0337480.ref029","doi-asserted-by":"crossref","first-page":"936662","DOI":"10.3389\/fimmu.2022.936662","article-title":"Association of longitudinal platelet count trajectory with ICU mortality: A multi-cohort study","volume":"13","author":"J Chen","year":"2022","journal-title":"Front Immunol"},{"issue":"1","key":"pone.0337480.ref030","doi-asserted-by":"crossref","first-page":"271","DOI":"10.20506\/rst.40.1.3224","article-title":"Bayesian latent class analysis when the reference test is imperfect","volume":"40","author":"A Cheung","year":"2021","journal-title":"Rev Sci Tech"},{"issue":"7","key":"pone.0337480.ref031","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1177\/0962280216673085","article-title":"Group-based multi-trajectory modeling","volume":"27","author":"DS Nagin","year":"2018","journal-title":"Stat Methods Med Res"},{"issue":"7","key":"pone.0337480.ref032","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciaa1131","article-title":"Latent Class Analysis and the Need for Clear Reporting of Methods","volume":"73","author":"E MacLean","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pone.0337480.ref033","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.2147\/CLEP.S265287","article-title":"Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches","volume":"12","author":"HL Nguena Nguefack","year":"2020","journal-title":"Clin Epidemiol"},{"issue":"4","key":"pone.0337480.ref034","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/00003246-200204000-00005","article-title":"Time course of platelet counts in critically ill patients","volume":"30","author":"S Akca","year":"2002","journal-title":"Crit Care Med"},{"issue":"5","key":"pone.0337480.ref035","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s10753-018-0810-y","article-title":"Mechanisms of Hemolysis During Sepsis","volume":"41","author":"K Effenberger-Neidnicht","year":"2018","journal-title":"Inflammation"},{"issue":"6","key":"pone.0337480.ref036","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1378\/chest.06-2233","article-title":"Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays","volume":"131","author":"D Moreau","year":"2007","journal-title":"Chest"},{"issue":"4","key":"pone.0337480.ref037","doi-asserted-by":"crossref","first-page":"741","DOI":"10.17305\/bb.2023.10135","article-title":"The role of platelets in sepsis: A review","volume":"24","author":"X Xu","year":"2024","journal-title":"Biomol Biomed"},{"issue":"1","key":"pone.0337480.ref038","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1186\/s12879-019-4388-2","article-title":"The effect of recombinant human thrombopoietin (rhTPO) on sepsis patients with acute severe thrombocytopenia: a study protocol for a multicentre randomised controlled trial (RESCUE trial)","volume":"19","author":"Z Zhou","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pone.0337480.ref039","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1111\/tme.12791","article-title":"Platelets inhibit erythrocyte invasion by Plasmodium falciparum at physiological platelet:erythrocyte ratios","volume":"32","author":"P Jongruamklang","year":"2022","journal-title":"Transfus Med"},{"issue":"4","key":"pone.0337480.ref040","first-page":"629","article-title":"Organ Dysfunction in Sepsis: An Ominous Trajectory From Infection To Death","volume":"92","author":"C Caraballo","year":"2019","journal-title":"Yale J Biol Med"},{"issue":"1","key":"pone.0337480.ref041","first-page":"41","article-title":"Lessons to learn from epidemiologic studies in ARDS","volume":"24","author":"BA McNicholas","year":"2018","journal-title":"Curr Opin Crit Care"},{"key":"pone.0337480.ref042","article-title":"Sepsis associated acute kidney injury","volume":"364","author":"JT Poston","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"pone.0337480.ref043","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13049-017-0355-3","article-title":"Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients","volume":"25","author":"COGENT (COhort of GEriatric Nephrology in NTUH) study group","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"5","key":"pone.0337480.ref044","doi-asserted-by":"crossref","first-page":"877","DOI":"10.3109\/0886022X.2015.1022851","article-title":"Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke","volume":"37","author":"H Fan","year":"2015","journal-title":"Ren Fail"},{"issue":"4","key":"pone.0337480.ref045","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1080\/09537104.2020.1754377","article-title":"Role of thrombocytopenia in risk stratification for acute kidney injury after living donor liver transplantation","volume":"32","author":"J Park","year":"2021","journal-title":"Platelets"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:27:10Z","timestamp":1764959230000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337480"}},"subtitle":[],"editor":[{"given":"Benjamin M.","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0337480","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}