血常规检查指标的新应用:RDW与MPV联合预测心衰患者死亡率

New Application Blood Test Indicators:To Evaluate the Effect of Mean Platelet Volume and Red Cell Distribution Width Predict Mortality in Patients with Heart Failure

目的研究联合红细胞体积分布宽度（Red Cell Distribution Width，RDW）和血小板平均体积（Meanplate Ietvolume，MPV）对心衰患者死亡风险的预测作用。方法选择阜外医院心衰住院患者1021例，记录他们入院时的RDW，MPV、左室射血分数（Left Ventricular Ejection Fraction，LVEF）以及其他临床和实验室指标。随访患者住院期间和出院后的死亡情况。结果随访21±9个月后，116例患者失访，137例死亡；死亡患者RDW中位数为14．8％，明显高于存活者的13．3％（P〈0．001），MPV在死亡组10．7％和存活组10．4％中同样存在显著差异（P〈0．01）；RDW的AUC为0．716（0．660～0．772，P〈0．001），RDW联合MPV的AUC为0．753（0．698～0．805，P〈0．001），NT-proBNP的AUC为0．814（0．769～0．859，P〈0．001）；将RDW和MPV两两组合进行生存分析，绘制生存曲线，发现在RDW≥13.4％，MPV≥10．5％组的患者中，患者生存率最低。结论联合RDW和MPV可以提高单独RDW对心衰患者死亡的预测价值。

Objective To evaluate the effect of Mean Platelet Volume and Red Cell Distribution Width predict mortality in patients with heart failure. Methods We retrospectively investigated 1021 HF patients at Fuwai Hospital. Clinical information on the patients, including RDW, MPV, LVEF and other laboratory tests , was recorded on admission. During the follow-up period, adverse events after discharge, such as rehospitalization due to HF or all-cause death, were recorded. Results Patients were median followed-up for 693days. During the follow-up period （21±9 months）, 116 participants were lost to follow-up, and 137 patients died, RDW median of 14.8% in the death group, significantly higher than 13.3% of survivors （P 〈0.001）, MPV in the death group 10.7and the survival group 10.4 also exists significant differences （P 〈0.01）; the AUC of RDW for predicting mortality was 0.716（0.660-0.772, P〈0.001）,the AUC of RDW and MPV for predicting mortality was 0.753（0.698-0.805, P〈0.001）; the AUC of NT-proBNP for predicting mortality was 0.814（0.769-0.859,P 〈0.001）; Kaplan-Meier analysis showed that the group of patients with RDW≥ 3.4% and MPV〉10.5% had the lowest cumulative survival in patients with HF. Conclusion RDW and MPV combination can improve the predictive value of a single RDW for the prognosis of patients with heart failure.