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U-shaped association between hemoglobin to red blood cell distribution width ratio and all-cause mortality among

Weichao He1, Jie Liu2, Rui Jiang3

  • 1Cangzhou Central Hospital, Department of Pediatrics, Cangzhou, Hebei Province, China.

Jornal De Pediatria
|December 12, 2025
PubMed

Insights

The hemoglobin to red blood cell distribution width ratio (HRR) shows a U-shaped association with 28-day mortality in pediatric intensive care unit (PICU) patients. Optimal outcomes were observed at an HRR of 8.91.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Clinical Outcomes Research

Background:

  • The hemoglobin to red blood cell distribution width ratio (HRR) is linked to mortality in adults, but its role in pediatric intensive care units (PICU) is not well-defined.
  • Understanding novel biomarkers like HRR is crucial for improving care in critically ill children.

Purpose of the Study:

  • To investigate the association between the hemoglobin to red blood cell distribution width ratio (HRR) and 28-day all-cause mortality in pediatric patients admitted to the ICU.
  • To identify a potential threshold for HRR associated with reduced mortality risk in this population.

Main Methods:

  • Retrospective cohort study utilizing data from a pediatric intensive care unit (PICU) database (2010-2018).
  • HRR calculated from laboratory tests within 24 hours of PICU admission.
  • Statistical analysis included multivariable logistic regression, restricted cubic splines, and threshold effects analysis to examine the HRR-mortality relationship.

Main Results:

  • The study included 8015 pediatric patients, with a 28-day in-hospital mortality rate of 4.1%.
  • A U-shaped relationship was observed between HRR and 28-day mortality, with an inflection point at an HRR of approximately 8.91.
  • Mortality risk was lower at an HRR of 8.91, with significantly different effect sizes on either side of this threshold (left: 0.803, right: 1.421).

Conclusions:

  • A U-shaped association exists between HRR and 28-day mortality in critically ill pediatric patients.
  • An HRR value around 8.91 appears to be associated with the lowest risk of mortality in this cohort.
  • These findings suggest HRR may serve as a prognostic indicator in pediatric critical care.
Abstract

Keywords:
Cohort studyHemoglobin and red blood cell distribution width (HRR)MortalityPediatric Intensive Care Unit (PIC) database

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