ROC曲线评价红细胞分布宽度对危重病患者预后的预测价值

Predictive value of ROC curve appraising red blood cell distribution width in prognosis of critically ill patients

目的研究红细胞分布宽度（RDW）对危重病患者预后的预测价值。方法选取河北省沧州市人民医院重症监护病房2013年6月—2015年1月资料完整的402例危重患者作为研究对象,记录患者入院后急性生理和慢性健康状况（APACHE）Ⅱ评分及RDW;根据APACHEⅡ评分将患者分为3组：〈10分组（A组）、10~20分组（B组）、〉20分组（C组）,比较3组患者的RDW水平和病死率;评价RDW与APACHEⅡ评分之间的相关性;根据患者预后分为死亡组（n=306）和存活组（n=96）,比较两组患者的APACHEⅡ评分RDW水平;利用受试者工作特征（ROC）曲线评价RDW在危重病患者预后判断中的作用。结果 B与A组比较,RDW升高,差异有统计学意义（P〈0.05）;C组患者RDW较A组患者显著升高（P〈0.01）。A、B、C 3组患者病死率分别为8.7%、16.7%和34.6%,C组病死率与A、B两组比较,差异均有统计学意义（P〈0.01）。随着APACHEⅡ评分的增加,RDW增加,病死率增加,APACHEⅡ评分与RDW呈正相关（r=0.69,P〈0.01）。死亡组患者APACHEⅡ评分高于存活组,入院时红RDW水平高于存活组,差异有统计学意义（P〈0.01）;RDW水平的ROC曲线下面积值为0.801;APACHEⅡ评分的ROC曲线下面积值为0.724（P〈0.01）。结论 RDW水平可能是预测危重患者转归较好的指标之一。

[ Objective] To study the predictive value of ROC curve appraising red blood cell distribution width（ RDW） in prognosis of critically ill patients. [ Methods] A total of 402 critically ill patients in ICU of Cangzhou People＇s Hospital from June 2013- January2015 were selected as study objects. Their APACHE Ⅱ score and RDW were recorded. According to APACHE score, these patients were divided into 10 points group（group A）, 10-20 points group（group B）, 20 points group（group C）, their RDW level and mortality rate were compared. the relationship between RDW and APACHE Ⅱ was analyzed. The patients were divided into death group（ n=306） and survival group（ n=96）, according to prognosis, APACHEⅡ score and RDW were compared between 2groups. The ROC curve was applied to appraise the effect of RDW in prognosis of critically ill patients.[ Results] In group B, the level of RDW was higher than that in group A（P〈0.05）. RDW in group C was significantly higher than that in group B（ P〈0.01）.The mortality rates in 3 groups were 8.7%, 16.7% and 34.6% respectively. The mortality of group C was significantly different with group A and B（ P〈0.01）. The APACHEⅡ score was positively related with RDW（ r=0.69,P〈0.01）. APACHEⅡ score of death group was higher than that in survival group（ P〈0.01）, RDW was also higher, with significant difference（ P〈0.01）. The area under the ROC curve of RDW was 0.801,and that of APACHE Ⅱ score was 0.724（ P〈0.01）.[ Conclusion] RDW is one of the good factors on evaluation of prognosis in the critically ill patients.