红细胞分布宽度与感染性休克患者预后关系研究

Investigation of the relationship between red cell distribution width and the prognosis in patients with septic shock

[摘要]目的探讨红细胞分布宽度（RDW）与感染性休克患者预后的关系。方法回顾性调查2010—06～2012—12人住本院重症医学科符合研究条件的感染性休克患者的病例资料，包括入科当日急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）及序贯器官衰竭评分（SOFA），人科当日血小板（PLT）、血小板分布宽度（PDW）、白细胞计数（WBC）、红细胞比容（HCT）、平均红细胞体积（MCV）、血红蛋白（Hb），入科第1、2、3、5、7天RDW，以人科后28d生存情况分为死亡组和存活组。先通过t检验分析死亡危险因素，对有统计学意义的危险因素再用多因素Logistic回归模型分析死亡优势比（OR）。根据多元Logistic回归分析得出的权重对SOFA评分、APACHEⅡ评分及RDWl加权求和得出SOFA＋RDWl、APACHEⅡ＋RDWl，与SOFA评分、APACHEⅡ评分、RDWl单个指标分别应用ROC曲线对预测感染性休克患者ICU28d病死率的应用价值进行评价，分别计算其曲线下面积（AUC）、敏感性、特异性、阳性预测值及阴性预测值。比较死亡组及存活组入科第1、2、3、5、7天RDW均值变化。结果Logistic回归分析显示，RDW回归系数为0．338，OR1．402（P=0．044，95％CI1．010—1．947），RDW每增加1％，ICU感染性休克患者28d死亡危险增加1．402倍；RDWl、APACHEⅡ评分、APACHEⅡ评分＋RDWl、SOFA评分、SOFA评分＋RDWl等指标对感染性休克患者28dICU病死率预测的AUC分别为0．632、0．802、0．817、0．852、0．841，敏感性分别为73．8％、87．7％、95．4％、70．8％、81．5％，阴性预测值分别为69．638％、84．942％、93．214％、74．723％、80．314％。死亡组第1、2、3、5、7天RDW均值逐步上升，而存活组均值变化无线性趋势。结论①RDW是ICU感染性休克患者28d病死率的独立危险因素；②RDW联合SOFA评分或APACHEⅡ评分均能提高预测ICU感染性休克患者28d病死率的敏感性；③RDW动态增高提示感染性休克患者预后不佳。

Objective To study the relationship between red cell distribution width （RDW） and prognosis in patients with septic shock. Methods We performed a retrospective analysis of patients with septic shock admitted to intensive care unit according with the enrollment condition from June 2010 to December 2012. The records included acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ ） score, and sequential organ failure assessment （SOFA） , PLT, PDW, WBC, HCT, MCV and Hb were collected on the first day of ICU. RDW on day 1, 2, 3, 5 and 7 of ICU was noted as RDW1, RDW2, RDW3, RDW5 and RDW7, respectively. According to the survival situation within the 28 days of ICU, the patients were divided into death group and survival group. We analyzed the risk factors for death by t - test, then we used the significant risk factors to analyze death advantage ratio （OR） by multi - factor Logistic regression model. The SOFA ＋ RDW1, APACHE I1 ＋ RDW1, SOFA score, APACHE U score, RDW1 were applied by ROC curves to evaluate the 28 - day ICU mortality in patientswith septic shock, the area under the curves （AUC）, sensitivity, specificity, positive predictive value and negative predictive value were calculated. The mean values of RDW1, RDW2, RDW3, RDW5 and RDW7 from death group and survival group were compared. Results Logistic regression analysis showed that the regression coefficient of RDW was 0. 338, odds ratio （OR） was 1. 402 （P = 0. 044, 95% CI 1.010 - 1. 947）, for each additional 1% RDW, the risk of 28 days of patients with sepsis shock in ICU increased 1. 402 times; the AUC calculated by ROC for RDW1, APACHE Ⅱscore, APACHE Ⅱ ＋ RDW1 SOFA score, SOFA ＋ RDW1 with 28 - day ICU mortality in patients with septic shock were 0. 632, 0. 802, O. 817, O. 852 and 0. 841, the sensitivity were 73.8%, 87.7%, 95.4%, 70.8% and 81.5%, the negative predictive value were 69. 638%, 84. 942%, 93. 214%, 74. 723% and 80.314%. The mean RDW from day 1 to day 7 in death group was gradually increased, but was not in a linear trend in the survival group. Conclusion ①RDW is an independent risk factor of 28 - day ICU mortality in patients with septic shock; ②RDW combined with SOFA score or APACHE Ⅱ score improves the predict sensitivity of 28 -day ICU mortality in patients with septic shock; ③The increased RDW indicates a poor prognosis of septic shock.