红细胞分布宽度对感染性休克患者预后的预测价值

Prognostic value of red blood cell distribution width in patients with septic shack

目的评估红细胞分布宽度对感染性休克患者预后的预测价值。方法采用回顾性研究的方法,将2009年11月—2012年10月收住杭州市第一人民医院的感染性休克患者219例纳入研究。记录休克发生24 h内的APACHEⅡ评分、SOFA评分、红细胞分布宽度(RDW)以及休克发生后90 d内的生存状况。结果死亡组RDW的均值高于存活组,RDW异常组病死率高于正常组,差异均有统计学意义(P<0.01);绘制Kaplan-Meier生存曲线,RDW正常组中位生存时间为40 d,而RDW异常组中位生存时间仅为4 d,差异有统计学意义(P<0.01);Cox比例风险回归分析,结果提示RDW、APACHEⅡ评分是患者死亡的独立危险因素,RDW每增加l%,感染性休克患者死亡风险增加1.122倍。通过ROC曲线分析显示,RDW、APACHEⅡ评分、SOFA评分均有统计学意义,单独应用各项指标评估,APACHEⅡ评分预测死亡的效能最高(AUC=0.873),RDW的预测能力(AUC=0.723)次之,SOFA评分最差(AUC=0.687)。而RDW联合APACHEⅡ评分则能带来更大的预测效能(AUC=0.894)。结论在感染性休克患者中,RDW升高增加死亡风险;在APACHEⅡ评分体系中加入RDW因素,可以提高对感染性休克患者预后判断的准确性。

Abstract： Objective To investigate the prognostic value of red blood cell distribution width in patients with septic shock. Methods Total of 219 patients with septic shock admitted from November 2010 to October 2012 were retrospec- tively studied. APACHE Ⅱ（acutephysiology＆chrmfic health evaluation Ⅱ ） score, SOFA （sequential organ failure assess- ment） score and RDW（ Red Blood Cell Distribution Width） at the beginning of and 24 hours after shock, as well as the outcome of Day 90 after the diagnosis were recorded. Results RDW were higher in non-survivors than those in survivors ; the mortality was higher in the abnormal RDW group than that in the normal RDW group ; the survival time was signifi- cantly longer in the abnormal RDW group than that in the normal group. The Cox proportional-hazard regression model was used to analyze correlation between the prognostic factor and the survival. Multivariate analysis revealed that the RDW and APACHE Ⅱwere dependent prognostic factors of septic shock. Estimating the receiver operating characteristic area under the curve（AUC） showed that RDW has very good discriminative power for hospital mortality （AUC --0. 723 ）. The AUC was 0. 873 for APACHE Ⅱ and 0. 687 for SOFA. When adding RDW to APACHEⅡ ,the AUC increased from 0. 873 to 0. 894. Conclusion Red cell distribution width of septic shock is a robust predictor of mortality. The sum of RDW and APACHEⅡ was a stronger predictor of mortality than either one alone.