红细胞分布宽度（RDW）对脓毒症诱发急性肾损伤（SI-AKI）患者的死亡率预测价值尚不清楚。本研究旨在调查入院时的RDW与SI-AKI患者预后之间的潜在关联。基于2022年6月发布的MIMIC-IV（2.0版）数据库为我们开展相关研究提供了SI-AKI患者的医疗数据。通过倾向评分匹配（PSM）方法，采用Cox比例风险回归分析评估与SI-AKI死亡率相关的主要危险因素，并建立预测性刻度表。利用一致性指数（C-index）和决策曲线分析验证该模型的预测能力和临床实用性。根据计算Youden指数的最大值，将SI-AKI患者分为高RDW组和低RDW组。根据过滤条件确定了共7574例SI-AKI患者。与低RDW组相比，高RDW组的28天（9.49% vs. 31.40%，P <0.001）和7天（3.96% vs. 13.93%，P <0.001）死亡率较高。高RDW组患者比低RDW组更容易发展为AKI（20.80% vs. 13.60%，P <0.001）。基于匹配患者，我们建立了一个包括年龄、白细胞、RDW、合并高血压和恶性肿瘤、使用血管活性药物、透析和侵袭性通气、序贯器官功能衰竭评估以及AKI分期的刻度表模型。预测28天生存概率的C-index为0.799。决策曲线分析显示，带有RDW的模型比不带RDW的模型具有更高的净益。目前的研究结果表明，RDW的重要性提高了对SI-AKI患者生存概率的刻度表模型的预测能力。© 2023 作者。

The predictive value of red blood cell distribution width (RDW) for mortality in patients with sepsis-induced acute kidney injury (SI-AKI) remains unclear. The present study aimed to investigate the potential association between RDW at admission and outcomes in patients with SI-AKI.The Medical Information Mart for Intensive Care (MIMIC)-IV (version 2.0) database, released in June of 2022, provides medical data of SI-AKI patients to conduct our related research. Based on propensity score matching (PSM) method, the main risk factors associated with mortality in SI-AKI were evaluated using Cox proportional hazards regression analysis to construct a predictive nomogram. The concordance index (C-index) and decision curve analysis were used to validate the predictive ability and clinical utility of this model. Patients with SI-AKI were classified into the high- and low-RDW groups according to the best cut-off value obtained by calculating the maximum value of the Youden index.A total of 7574 patients with SI-AKI were identified according to the filter criteria. Compared with the low-RDW group, the high-RDW group had higher 28-day (9.49% vs. 31.40%, respectively, P <0.001) and 7-day (3.96% vs. 13.93%, respectively, P <0.001) mortality rates. Patients in the high-RDW group were more prone to AKI progression than those in the low-RDW group (20.80% vs. 13.60%, respectively, P <0.001). Based on matched patients, we developed a nomogram model that included age, white blood cells, RDW, combined hypertension and presence of a malignant tumor, treatment with vasopressor, dialysis, and invasive ventilation, sequential organ failure assessment, and AKI stages. The C-index for predicting the probability of 28-day survival was 0.799. Decision curve analysis revealed that the model with RDW offered greater net benefit than that without RDW.The present findings demonstrated the importance of RDW, which improved the predictive ability of the nomogram model for the probability of survival in patients with SI-AKI.© 2023 The Author(s).