红细胞分布宽度联合N末端B型利钠肽原评估老年急性心力衰竭预后的价值

Prognostic value of red blood cell distribution width combined with N-terminal pro-brain natriuretic peptide on evaluating acute heart failure in elderly patients

目的:探讨红细胞分布宽度(RDW)联合N末端B型利钠肽原(NT-proBNP)评估老年急性心力衰竭(AHF)预后的价值。方法:采用单中心回顾性观察性研究,选取我院急诊科确诊为AHF的老年患者150例,根据入院后90 d内是否发生终点事件(患者全因死亡或再次因急性心力衰竭入院)分为预后不良组和非预后不良组。比较2组患者RDW、NT-proBNP和其他参数的差异。利用SPSS 19.0和Medcalc软件对数据进行统计分析。组间比较采用t检验、Mann-Whitney U检验、卡方检验。应用受试者工作特征(ROC)曲线分析RDW联合NT-proBNP对老年AHF不良预后的评估价值。结果:90 d内发生终点事件56例,终点事件发生率37.3%。包括AHF再入院47例,发生率31.3%;死亡9例,发生率6%。预后不良组RDW值高于非预后不良组[(13.6±1.2)vs.(12.5±1.3),P=0.000]。ROC曲线结果显示入院时血RDW水平的ROC曲线下面积为0.756(95%CI:0.680-0.823,P<0.01),截断值为13.2%时的评估预后的敏感度为69.6%,特异度为62.8%,阳性似然比为1.87,阴性似然比为0.48。入院时的NT-proBNP水平的ROC曲线下面积为0.689(95%CI:0.608-0.762,P<0.01),截断值为4878ng/mL时的评估预后的敏感度为67.9%,特异度为61.7%,阳性似然比为1.77,阴性似然比为0.52。RDW联合NT-proBNP的ROC曲线下面积为0.813(95%CI:0.742-0.872,P<0.01),评估预后的敏感度为82.1%,特异度为72.3%,阳性似然比为2.97,阴性似然比为0.25。两者联合较任何单一指标有更高的预后预测价值(P<0.05)。结论:入院时RDW联合NT-proBNP可较好预测老年AHF90 d不良预后。

Objective:To evaluate the prognostic value of the combined measurement of red blood cell distribution width(RDW)and N-terminal pro-brain natriuretic peptide(NT-proBNP)consentrations in the elderly with acute heart failure(AHF).Method:We retrospectively studied 150 elderly patients who were admitted for acute AHF in Beijing Hospital.The observational period was defined as 90 days from admission,and the study endpoint was defined as all cause death or re-hospitalization due to AHF.According to the occurrence of endpoint events,the patients were divided into poor prognosis group(n=56)and non-poor prognosis group(n=94).Blood sampling of RDW,NT-proBNP levels and other clinical data was compared between the two groups.SPSS 19.0 and Medcalc software was used to analyze the data.The data was compared by student’s t test,Mann-Whitney U test or Chi-square test,the receiver operating characteristic(ROC)curve was used to analyze the prognostic value of RDW combined with NT-proBNP on evaluating AHF in elderly patients.Result:During 90 days,56 patients had poor prognosis,the ratio was 37.3%.47 patients(31.3%)were readmitted for AHF and 9(6%)died.The serum RDW level was significantly higher in the poor prognosis group than that in the non-poor prognosis group[(13.6±1.2)vs.(12.5±1.3),P=0.000].When the cutoff value of RDW was 13.2%,the area under ROC curve(AUC)was 0.756(95%CI:0.680-0.823,P<0.01),with sensitivity 69.6%,specificity 62.8%,the positive likelihood ratio(LR)was 1.87,the negative LR was 0.48.When the cutoff value of NT-proBNP was 4878 ng/mL,The AUC was 0.689(95%CI:0.608-0.762,P<0.01),with sensitivity 67.9%,specificity 61.7%,the positive LR was 1.77,the negative LR was 0.52.When combining NT-proBNP and RDW,the AUC was 0.813(95%CI:0.742-0.872,P<0.01),with sensitivity 82.1%,specificity 72.3%,the positive LR was 2.97,the negative LR was 0.25.Conclusion:RDW in combination with NT-proBNP at admission can be used to evaluate 90-day poor prognosis of AHF in elderly patients.