红细胞分布宽度预测心脏术后连续性肾脏替代治疗患者预后的价值

Red blood cell distribution width may be a novel prognostic marker for mortality in patients on continuous renal replacement therapy due to acute kidney injury following cardiac surgery

目的探讨红细胞分布宽度(RDW)对心脏手术后连续性肾脏替代治疗(CRRT)患者预后的预测价值。方法收集2012年1月到2013年6月因心脏手术后急性肾损伤(AKI)接受连续性静静脉血液透析滤过(CVVHDF)治疗的成年患者(既往无慢性肾脏病病史),以28天为界分为存活组和死亡组,比较并分析心脏手术前及接受CRRT治疗首日2组患者的相关临床资料。以红细胞分布宽度(RDW)≥15%或<15%为界进一步分组,探讨RDW对患者死亡的预测效力和累积生存率的影响。结果本研究共纳入17例心脏术后AKI并接受CVVHDF治疗的患者。其中6例存活,11例死亡。死亡组RDW和SOFA评分显著高于存活组(P=0.048,0.014)。RDW和SOFA评分预测28天死亡的ROC曲线下面积(AUC)分别为0.765和0.848(P=0.024,0.0002),但二者差异无统计学意义(P=0.541)。RDW≥15%患者28天死亡率显著高于RDW<15%患者(P=0.038)。结论 RDW可能是心脏术后AKI接受CRRT治疗患者的死亡预测因子。

Objectives To evaluate the value of red blood cell distribution width （RDW） for the prediction of mortality in patients on continuous renal replacement therapy （CRRT） due to acute kidney injury （AKI） following cardiac surgery. Methods Patients without any history of chronic kidney diseases but with AKI following cardiac surgery and underwent continuous veno-venous hemodiafilitration （CVVHDF） in our medical center from January 2012 to June 2013 were enrolled in this study. They were assigned into either survival group or death group. Data from pre-surgery and pre-CVVHDF were collected and analyzed. The value of RDW for mortality prediction was assessed by receiver operator curve, and the 28-day survival rate between high-level and low-level RDW groups was further compared. Results Seventeen adult patients with AKI following cardiac surgery and underwent CVVHDF were enrolled in this study. Six patients survived and 11 patients died, with the mortality of 64.7%. The death group showed a higher level of RDW and SOFA score than those in the survival group （P=0.048 and 0.014, respectively）. The area under receiver operator curve （AUC） for mortality prediction was 0.765 for RDW and 0.848 for SOFA score （P=0.024 and 0.0002, respectively）, and there was no statistical significance between RDW and SOFA scores （P=0.541）. Patients with a RDW level 〉15% exhibited significantly higher 28-day mortality rate than those with lower RDW level （P= 0.038）. Conclusions The present study demonstrated that RDW may be an additive predictor for mortality in patients on CRRT due to AKI following cardiac surgery.