红细胞容积分布宽度与肾移植术后ARDS患者病死率的相关性分析

Correlation analysis between red cell volume distribution width and the mortality rate in ARDS patients after renal transplantation

目的探讨红细胞容积分布宽度(RDW)与肾移植术后急性呼吸窘迫综合征(ARDS)患者病死率的相关性。方法回顾性分析106例肾移植术后ARDS患者的临床资料,根据RDW的高低分为RDW正常组(≤15.0%,68例)和RDW升高组(>15.0%,38例)。比较两组患者的基本情况和不良事件发生情况,绘制Kaplan-Meier曲线比较两组的50 d病死率,采用Cox比例风险回归分析ARDS患者死亡的风险因素。结果 106例患者中,50 d内死亡总例数为46例(43.4%)。两组在序贯器官衰竭评估(SOFA)评分、血清肌酐、血红蛋白及血小板计数的差异有统计学意义(均为P<0.05)。RDW升高组患者的50 d病死率及感染性休克发生率明显高于RDW正常组,差异均有统计学意义(均为P<0.05),Kaplan-Meier生存曲线分析表明,RDW升高组与正常组患者的50 d病死率差异有统计学意义(P<0.01)。Cox比例风险回归法单因素分析发现,血红蛋白<100 g/L、血清肌酐>133μmol/L、血小板计数<100×109/L、重度ARDS、RDW>15.0%均为ARDS患者50 d内死亡的潜在危险因素(均为P<0.05)。多因素分析发现,重度ARDS[比值比(OR)=12.77,95%可信区间(CI)11.63~15.39,P<0.001]和RDW>15.0%(OR=2.01,95%CI 1.02~3.94,P<0.043)为ARDS患者50 d内死亡的独立危险因素。结论 RDW升高与肾移植术后ARDS患者疾病严重程度和50 d病死率相关,可以作为一项较有意义的预测肾移植术后ARDS患者预后的临床指标。

Objective To investigate the correlation between red cell volume distribution width（RDW） and the mortality rate of acute respiratory distress syndrome（ARDS） patients after renal transplantation. Methods Clinical data of 106 ARDS patients undergoing renal transplantation were retrospectively analyzed. According to RDW, all patients were assigned into the normal（≤15.0%, n=68） and increasing RDW groups（15.0%, n=38）. Baseline data and the incidence of adverse events were statistically compared between two groups. Kaplan-Meier survival curve was adopted to compare the 50 d-mortality rate between two groups. Cox＇s proportional hazards regression model was utilized to identify the risk factors of the mortality of ARDS patients. Results Among 106 patients, the 50 d-mortality rate was calculated as 43.4%（46/106）. The sequential organ failure assessment（SOFA） score, serum creatinine, hemoglobin and platelet count significantly differed between two groups（all P〈0.05）. In the increasing RDW group, the 50 d-mortality rate and the incidence of infectious shock were significantly higher than those in the normal RDW group（both P〈0.05）. KaplanMeier survival curve demonstrated that the 50 d-mortality rate significantly differed between two groups（P〈0.01）. Cox＇s proportional hazards regression model univariate analysis revealed that hemoglobin level100 g/L, serum creatinine 133 μmol/L, platelet count100×109/L, severe ARDS and RDW15.0% were the potential risk factors of the 50 d-mortality rate in ARDS patients（all P〈0.05）. Multivariate analysis demonstrated that severe ARDS [odd ratio（OR）=12.77, 95% confidence interval（CI） 11.63-15.39, P0.001] and RDW15.0%（OR=2.01, 95%CI 1.02-3.94, P0.043） were the independent risk factors of the 50 d-mortality rate in ARDS patients. Conclusions RDW elevation is correlated with the severity of disease and 50 d-mortality rate in ARDS patients following renal transplantation. RDW can serve as a clinical parameter to predict the prognosis of ARDS patients after renal transplantation.