{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:14:39Z","timestamp":1783448079231,"version":"3.55.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jinshan Hospital Affiliated with Fudan University","award":["Reserve discipline construction of Jinshan Hospital Affiliated with Fudan University (No. ZDXK-2025-7)"],"award-info":[{"award-number":["Reserve discipline construction of Jinshan Hospital Affiliated with Fudan University (No. ZDXK-2025-7)"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n The hemoglobin-to-red cell distribution width ratio (HRR) is a biomarker associated with systemic inflammation and outcomes in critical illness. Within clinical databases, there exists an extreme-prognosis subgroup of inflammatory bowel disease (IBD) patients, those who all died within 30 days of ICU admission. Due to limitations in the database, this study can only analyze this specific subgroup.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to explore and describe the association between admission HRR and the occurrence of sepsis during ICU stay in this specific subgroup of IBD patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted using the eICU Collaborative Research Database (2014\u20132015), including 229 eligible patients. Multivariable logistic regression was used to assess the independent association, adjusting for confounders. The dose-response relationship was examined using restricted cubic spline (RCS) models. Subgroup and interaction analyses were performed across age, sex, and race.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The sepsis group had a significantly lower admission HRR than the non-sepsis group (6.04\u2009\u00b1\u20091.66 vs. 6.77\u2009\u00b1\u20092.0, P\u2009=\u20090.008). After full adjustment, each 1-unit increase in HRR was associated with 20.3% lower odds of sepsis (P\u2009=\u20090.007). Compared to the lowest quartile (HRR\u2009<\u20095.1), patients in the highest quartile (HRR\u2009\u2265\u20097.85) had 66.8% lower adjusted odds of sepsis (P\u2009=\u20090.015). RCS analysis indicated a linear, inverse relationship between HRR and sepsis (P for non-linearity\u2009=\u20090.42). Subgroup analysis revealed the negative association was more pronounced in patients aged <65, males, and White patients. However, formal interaction tests were not statistically significant (all P for interaction >0.05), indicating the association did not differ meaningfully across these subgroups.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this specific cohort, a lower admission HRR was associated with the occurrence of sepsis. Due to inherent selection bias, this finding describes an association within this specific subgroup and cannot be generalized. This exploratory study generates the hypothesis that HRR may reflect a unique pathophysiological state in end-stage IBD, a hypothesis that requires validation in prospective, unbiased cohorts.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0353237","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:24:07Z","timestamp":1783445047000},"page":"e0353237","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between hemoglobin-to-red cell distribution width ratio and occurrence of sepsis during ICU stay in inflammatory bowel disease patients who died: a retrospective study using the EICU-CRD database"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4564-6915","authenticated-orcid":true,"given":"Yulin","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"3","key":"pone.0353237.ref001","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.pop.2023.03.009","article-title":"Inflammatory Bowel Disease","volume":"50","author":"LP Bruner","year":"2023","journal-title":"Primary Care"},{"issue":"1","key":"pone.0353237.ref002","first-page":"5","article-title":"The Influence of the Inflammatory Bowel Diseases on the Perceived Stress and Quality of Life in a Sample of the South-Western Romanian Population","volume":"48","author":"D-E Popa","year":"2022","journal-title":"Curr Health Sci J"},{"issue":"6","key":"pone.0353237.ref003","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/MCG.0b013e318275d981","article-title":"Clinical presentation and outcomes of inflammatory bowel disease patients admitted to the intensive care unit","volume":"47","author":"C Ha","year":"2013","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"pone.0353237.ref004","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/SHK.0000000000000742","article-title":"Severe Sepsis Outcomes Among Hospitalizations With Inflammatory Bowel Disease","volume":"47","author":"JF Colbert","year":"2017","journal-title":"Shock"},{"issue":"14","key":"pone.0353237.ref005","first-page":"668","article-title":"Life-threatening complications of Crohn\u2019s disease and ulcerative colitis: a systematic analysis of admissions to an ICU during 18 years","volume":"135","author":"W Huber","year":"2010","journal-title":"Deutsche medizinische Wochenschrift"},{"issue":"3","key":"pone.0353237.ref006","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations","volume":"193","author":"C Fleischmann","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"pone.0353237.ref007","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.ajem.2016.10.055","article-title":"Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients","volume":"35","author":"SY Hwang","year":"2017","journal-title":"Am J Emerg Med"},{"key":"pone.0353237.ref008","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.3389\/fimmu.2019.02204","article-title":"The Era of Thromboinflammation: Platelets Are Dynamic Sensors and Effector Cells During Infectious Diseases","volume":"10","author":"L Guo","year":"2019","journal-title":"Front Immunol"},{"issue":"9","key":"pone.0353237.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-062245","article-title":"Enhanced red blood cell distribution width to platelet ratio is a predictor of mortality in patients with sepsis: a propensity score matching analysis based on the MIMIC-IV database","volume":"12","author":"Y Zhou","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0353237.ref010","doi-asserted-by":"crossref","first-page":"997853","DOI":"10.3389\/fimmu.2022.997853","article-title":"Diagnostic value of RDW for the prediction of mortality in adult sepsis patients: A systematic review and meta-analysis","volume":"13","author":"H Wu","year":"2022","journal-title":"Front Immunol"},{"key":"pone.0353237.ref011","doi-asserted-by":"crossref","first-page":"1603104","DOI":"10.3389\/fcimb.2025.1603104","article-title":"The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database","volume":"15","author":"J Lou","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"issue":"5","key":"pone.0353237.ref012","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s40292-024-00662-0","article-title":"Red blood cell distribution width is a biomarker of red cell dysfunction associated with high systemic inflammation and a prognostic marker in heart failure and cardiovascular disease: a potential predictor of atrial fibrillation recurrence","volume":"31","author":"A Garc\u00eda-Escobar","year":"2024","journal-title":"High blood pressure & cardiovascular prevention: the official journal of the Italian Society of Hypertension"},{"issue":"1","key":"pone.0353237.ref013","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2217\/bmm-2021-0364","article-title":"Red blood cell distribution width as a prognostic biomarker for viral infections: prospects and challenges","volume":"16","author":"O Owoicho","year":"2022","journal-title":"Biomark Med"},{"issue":"2","key":"pone.0353237.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/rmv.2264","article-title":"Role of red blood cell distribution width, as a prognostic indicator in COVID-19: A systematic review and meta-analysis","volume":"32","author":"S Sarkar","year":"2022","journal-title":"Rev Med Virol"},{"key":"pone.0353237.ref015","doi-asserted-by":"crossref","first-page":"997356","DOI":"10.3389\/fnut.2022.997356","article-title":"Clinical and inflammatory biomarkers of inflammatory bowel diseases are linked to plasma trace elements and toxic metals; new insights into an old concept","volume":"9","author":"C Amerikanou","year":"2022","journal-title":"Front Nutr"},{"issue":"7351","key":"pone.0353237.ref016","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1038\/nature10209","article-title":"Genetics and pathogenesis of inflammatory bowel disease","volume":"474","author":"B Khor","year":"2011","journal-title":"Nature"},{"issue":"1","key":"pone.0353237.ref017","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1038\/s41398-025-03647-2","article-title":"The interaction and joint effects of the hemoglobin-to-red cell distribution width ratio and the triglyceride-glucose index (TyG) on depressive symptoms among residents of Nanjing City, along with the mediating role of TyG: a population-based study of 181,752 participants","volume":"15","author":"M Jiang","year":"2025","journal-title":"Transl Psychiatry"},{"issue":"1","key":"pone.0353237.ref018","doi-asserted-by":"crossref","first-page":"28098","DOI":"10.1038\/s41598-024-79520-x","article-title":"Hemoglobin-to-red blood cell distribution width ratio is negatively associated with stroke: a cross-sectional study from NHANES","volume":"14","author":"Y Xiong","year":"2024","journal-title":"Sci Rep"},{"key":"pone.0353237.ref019","doi-asserted-by":"crossref","first-page":"1534479","DOI":"10.3389\/fphar.2025.1534479","article-title":"Hemoglobin-to-red blood cell distribution width ratio as a protective factor against coronary artery disease: a cross-sectional analysis of NHANES (2011-2018)","volume":"16","author":"X-D Wang","year":"2025","journal-title":"Front Pharmacol"},{"issue":"11","key":"pone.0353237.ref020","first-page":"400","article-title":"Relationship between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Septic Patients with Atrial Fibrillation: Based on Propensity Score Matching Method","volume":"9","author":"J Wang","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"issue":"3","key":"pone.0353237.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-081340","article-title":"Association between haemoglobin-to-red blood cell distribution width ratio at admission and all-cause mortality in adult patients with sepsis in an intensive care unit: a secondary analysis of the MIMIC-IV database","volume":"14","author":"L Zhong","year":"2024","journal-title":"BMJ Open"},{"key":"pone.0353237.ref022","doi-asserted-by":"crossref","first-page":"7141216","DOI":"10.1155\/2022\/7141216","article-title":"The Hemoglobin-to-Red Cell Distribution Width Ratio to Predict All-Cause Mortality in Patients with Sepsis-Associated Encephalopathy in the MIMIC-IV Database","volume":"2022","author":"X Huang","year":"2022","journal-title":"Int J Clin Pract"},{"issue":"11","key":"pone.0353237.ref023","doi-asserted-by":"crossref","first-page":"620","DOI":"10.3390\/metabo14110620","article-title":"The roles of vitamin D levels, gla-rich protein (GRP) and matrix gla protein (MGP), and inflammatory markers in predicting mortality in intensive care patients: a new biomarker link?","volume":"14","author":"F Se\u011fmen","year":"2024","journal-title":"Metabolites"},{"key":"pone.0353237.ref024","doi-asserted-by":"crossref","first-page":"180178","DOI":"10.1038\/sdata.2018.178","article-title":"The eICU Collaborative Research Database, a freely available multi-center database for critical care research","volume":"5","author":"TJ Pollard","year":"2018","journal-title":"Sci Data"},{"issue":"6","key":"pone.0353237.ref025","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.annemergmed.2016.07.008","article-title":"Sepsis-3 definitions","volume":"68","author":"N Gheen","year":"2016","journal-title":"Ann Emerg Med"},{"issue":"13","key":"pone.0353237.ref026","doi-asserted-by":"crossref","first-page":"4464","DOI":"10.3390\/jcm14134464","article-title":"Hemoglobin-to-Red Cell Distribution Width Ratio Was Associated with Cardiovascular Diseases and Death","volume":"14","author":"M Li","year":"2025","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0353237.ref027","doi-asserted-by":"crossref","first-page":"23070","DOI":"10.1038\/s41598-025-07431-6","article-title":"Machine learning model and hemoglobin to red cell distribution width ratio evaluates all-cause mortality in pulmonary embolism","volume":"15","author":"D Du","year":"2025","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0353237.ref028","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1186\/s12890-024-03229-w","article-title":"Predictive role of red blood cell distribution width and hemoglobin-to-red blood cell distribution width ratio for mortality in patients with COPD: evidence from NHANES 1999-2018","volume":"24","author":"S Liu","year":"2024","journal-title":"BMC Pulm Med"},{"key":"pone.0353237.ref029","doi-asserted-by":"crossref","first-page":"726025","DOI":"10.3389\/fcvm.2022.726025","article-title":"Hemoglobin-to-Red-Cell Distribution Width Ratio Is a Novel Predictor of Long-Term Patient Outcomes After Percutaneous Coronary Intervention: A Retrospective Cohort Study","volume":"9","author":"W-J Xiu","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"4","key":"pone.0353237.ref030","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1159\/000550890","article-title":"Hemoglobin-to-Red Cell Distribution Width Ratio at Admission as an Anemia-Independent Predictor of Mortality after Fragility Hip Fracture Surgery in Older Adults","volume":"72","author":"S-P Yoon","year":"2026","journal-title":"Gerontology"},{"key":"pone.0353237.ref031","doi-asserted-by":"crossref","first-page":"1555082","DOI":"10.3389\/fendo.2025.1555082","article-title":"Association between serum glucose potassium ratio and short- and long-term all-cause mortality in patients with sepsis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database","volume":"16","author":"J Lou","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0353237.ref032","doi-asserted-by":"crossref","first-page":"1602921","DOI":"10.3389\/fcimb.2025.1602921","article-title":"The non-linear association between creatinine-to-albumin ratio and medium-term mortality in patients with sepsis accompanied by acute kidney injury in the intensive care unit: a retrospective study based on the MIMIC database and external validation","volume":"15","author":"J Lou","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"issue":"2","key":"pone.0353237.ref033","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3109\/10408363.2014.992064","article-title":"Red blood cell distribution width: A simple parameter with multiple clinical applications","volume":"52","author":"GL Salvagno","year":"2015","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"12","key":"pone.0353237.ref034","article-title":"Association of the PaO2\/RDW ratio with 7-day mortality and risk of early invasive mechanical ventilation in ICU patients with delirium associated with ARDS: A retrospective cohort study from the MIMIC-IV database","volume":"20","author":"J Xu","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pone.0353237.ref035","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1111\/ggi.70023","article-title":"Hemoglobin to red cell distribution width ratio predicts postoperative delirium in older patients undergoing hip fracture surgery: A retrospective cohort study","volume":"25","author":"X Cao","year":"2025","journal-title":"Geriatr Gerontol Int"},{"key":"pone.0353237.ref036","doi-asserted-by":"crossref","first-page":"1576141","DOI":"10.3389\/fimmu.2025.1576141","article-title":"Advances in gut-lung axis research: clinical perspectives on pneumonia prevention and treatment","volume":"16","author":"F Ye","year":"2025","journal-title":"Front Immunol"},{"issue":"9","key":"pone.0353237.ref037","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.3390\/ijms19092465","article-title":"Calcium Ion Channels: Roles in Infection and Sepsis Mechanisms of Calcium Channel Blocker Benefits in Immunocompromised Patients at Risk for Infection","volume":"19","author":"JA D\u2019Elia","year":"2018","journal-title":"Int J Mol Sci"},{"key":"pone.0353237.ref038","doi-asserted-by":"crossref","first-page":"1638290","DOI":"10.3389\/fpubh.2025.1638290","article-title":"Association between hemoglobin-to-red cell distribution width ratio and depression in Chinese adults: a population-based cross-sectional study","volume":"13","author":"Y Xu","year":"2025","journal-title":"Front Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:24:17Z","timestamp":1783445057000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353237"}},"subtitle":[],"editor":[{"given":"Samiullah","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353237","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]}}}