红细胞分布宽度对感染患者预后的评估价值

Value of red blood cell distribution width in the prognosis of patients with bloodstream infection

目的探讨细菌感染患者的红细胞分布宽度(RDW)与疾病危重程度及预后的关系。方法采用回顾性研究,选择安徽医科大学附属省立医院2013-2015年综合ICU血培养阳性患者112例,统计分析患者的急性生理与慢性健康评估Ⅱ(APACHE-II)评分、RDW、红细胞平均体积、血红蛋白、C反应蛋白(CRP)、降钙素原(PCT)和血清肌酐。根据患者的预后情况分为存活组和死亡组,对两组的相关指标进行比较。采用Spearman's相关性分析RDW与相应检测指标的相关性,采用多因素Logistic回归分析影响预后的独立危险因素,绘制受试者工作特征(ROC)曲线计算曲线下面积,比较危险因素对感染患者的死亡预测价值。采用Kaplan-Meier生存分析,按RDW分层,绘制30 d生存曲线,比较RDW值与死亡预后的关系。结果 RDW与CRP、PCT、APACHEⅡ评分呈正相关(r值分别为0.225、0.266、0.267,P<0.05);Logistic回归分析显示,RDW和APACHEⅡ评分是影响感染患者预后的独立危险因素;RDW的ROC曲线的曲线下面积为0.634,灵敏度为0.600,特异度为0.641。结论 RDW可以作为预测细菌感染患者预后的参考指标,对感染患者的预后具有较好的灵敏度。

Objective To study the relationship between red blood cell distribution width（RDW） and prognosis in patients with bloodstream infection. Methods A total of 112 patients with positive blood culture were identified from ICU in Anhui Provincial Hospital Affiliated to Anhui Medical University from 2013 to 2015. The clinical data were reviewed and analyzed, including the acute physiology and chronic health assessment II（APACHE-Ⅱ） score, RDW, average volume of red blood cells, hemoglobin, C-reactive protein（CRP）, procalcitonin（PCT） and serum creatinine. Patients were summarized to compare relevant laboratory tests in terms of survival status. The correlation between RDW and corresponding tests was analyzed by Spearman＇s correlation. Multivariate logistic regression analysis was used to analyze the independent risk factors of prognosis. The area under the curve（AUC） was calculated by ROC curve to predict the risk of death. Kaplan-Meier survival analysis was used to plot the 30-day survival curve. The relationship between RDW and the risk of death was estimated. Results There was a positive correlation between RDW and CRP, PCT and APACHE Ⅱ score（r=0.225, 0.266, 0.267, P〈0.05）. Logistic regression analysis showed that RDW and APACHE Ⅱ score were independent risk factors for the prognosis of the patients with bloodstream infection. The lower AUC of RDW was 0.634 associated with sensitivity of 0.600, and specificity of 0.641. Conclusions RDW can be used as a sensitive predictor of prognosis in patients with bloodstream infection.