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Correlation between the white blood cell/platelet ratio and 28-day all-cause mortality in cardiac arrest patients: a
Huai Huang1, Guangqin Ren2, Shanghui Sun3
1Department of Neurological Rehabilitation, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Objective:
This study aims to evaluate the association between the white blood cell-to-platelet ratio (WPR) and 28-day all-cause mortality among patients experiencing cardiac arrest.
Methods:
Utilizing data from 748 cardiac arrest patients in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 2.2 database, machine learning algorithms, including the Boruta feature selection method, random forest modeling, and SHAP value analysis, were applied to identify significant prognostic biomarkers. Key patient characteristics, encompassing demographic data, comorbidities, hematological and biochemical indices, and vital signs, were extracted using PostgreSQL Administration Tool (pgAdmin) software. The Cox proportional hazards model assessed the impact of WPR on mortality outcomes, while Kaplan-Meier survival curves and restricted cubic spline (RCS) analysis further validated the findings. Subgroup analyses stratified the prognostic value of WPR by demographic and clinical factors.
Results:
WPR demonstrated the highest prognostic significance among the variables studied, showing a strong association with 28-day all-cause mortality. In the unadjusted Model 1, hazard ratios (HRs) for WPR quartiles ranged from 1.88 (95% CI: 1.22-2.90) in Q2 to 3.02 (95% CI: 2.04-4.47) in Q4 (Ptrend <0.05). Adjusted models (Models 2-4) confirmed the robustness of these associations, even after accounting for demographic and clinical covariates. Kaplan-Meier and RCS analyses revealed a significant U-shaped relationship between WPR and mortality risk. Subgroup analyses indicated that elevated WPR was particularly associated with increased mortality in males, elderly patients, married individuals, and those with chronic pulmonary disease.
Conclusion:
WPR serves as an independent and reliable prognostic biomarker for 28-day mortality in cardiac arrest patients. Its integration into clinical decision-making may enhance the early identification of high-risk patients and guide tailored therapeutic interventions.
Insights
The white blood cell-to-platelet ratio (WPR) is a significant predictor of 28-day mortality in cardiac arrest patients. Higher WPR levels are associated with increased mortality risk, aiding in early identification of high-risk individuals.
Area of Science:
- Critical Care Medicine
- Hematology
- Biomarker Discovery
Background:
- Cardiac arrest poses a significant mortality risk.
- Identifying reliable prognostic biomarkers is crucial for patient management.
- The prognostic value of the white blood cell-to-platelet ratio (WPR) in cardiac arrest is not well-established.
Purpose of the Study:
- To evaluate the association between the white blood cell-to-platelet ratio (WPR) and 28-day all-cause mortality in cardiac arrest patients.
- To determine if WPR can serve as an independent prognostic biomarker.
- To explore the relationship between WPR and mortality across different patient subgroups.
Main Methods:
- Retrospective analysis of 748 cardiac arrest patients from the MIMIC-IV database.
- Application of machine learning algorithms (Boruta, random forest, SHAP) for biomarker identification.
- Cox proportional hazards model, Kaplan-Meier curves, and restricted cubic spline analysis to assess WPR's prognostic impact.
Main Results:
- The white blood cell-to-platelet ratio (WPR) showed the highest prognostic significance for 28-day mortality.
- A significant U-shaped relationship was observed between WPR and mortality risk.
- Elevated WPR was linked to increased mortality in males, elderly, married patients, and those with COPD.
Conclusions:
- The white blood cell-to-platelet ratio (WPR) is an independent and reliable prognostic biomarker for 28-day mortality in cardiac arrest.
- WPR can aid in early identification of high-risk patients.
- Clinical integration of WPR may guide tailored therapeutic interventions for improved outcomes.
