基于数据挖掘评估红细胞分布宽度对脓毒性休克患者预后的预测价值

Predictive Value of Red Blood Cell Distribution Width for Prognosis of Patients with Septic Shock Based on Data Mining

目的:探讨红细胞分布宽度(red blood cell distribution width,RDW)对脓毒性休克患者预后的预测价值。方法:采用重症监护医学信息市场(MIMIC-Ⅲ)数据库作为数据来源。根据脓毒症诊断标准提取MIMIC-Ⅲ数据库中的脓毒性休克患者。根据RDW是否升高,将患者分为正常组和升高组。收集患者一般资料,以序贯性脏器功能衰竭评分(sequential organ failure assessment score,SOFA)进行评价,记录患者脓毒性休克的转归情况。结果:共纳入808例脓毒性休克患者,28 d死亡率26.9%。与正常组相比,升高组患者较多合并慢性心衰、糖尿病及慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)(P <0.05),具有较高的SOFA评分,行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)及机械通气的比例均明显升高,ICU停留时间明显延长,28 d死亡率升高(P <0.01)。Cox比例风险回归分析结果提示RDW升高是脓毒性休克患者死亡的独立危险因素(OR =1.0950,95%CI =1.0536~1.1365,P <0.001)。结论:初始RDW值升高与脓毒性休克患者28 d死亡率显著相关。

Objective: To explore the predictive value of red blood cell distribution width(RDW) for prognosis of patients with septic shock. Methods: We used Medical Information Mart for Intensive Care Ⅲ(MIMIC-III) database as data source. The patients with sepsis in the MIMIC-Ⅲ database were extracted according to the diagnostic criteria for sepsis. According to whether the RDW is elevated, the patients are divided into normal group and elevated group. General data of patients were collected and evaluated by sequential organ failure assessment score(SOFA), and their turnover were recorded.Results: A total number of 808 patients with septic shock were included. The 28-day mortality of the patients with septic shock was 26.9%. Compared with the normal group, the patients in the elevated group were more likely to have chronic heart failure, diabetes and chronic obstructive pulmonary disease(COPD), and had a higher SOFA score. The proportion of continuous renal replacement therapy(CRRT)and mechanical ventilation was significantly increased, and the Intensive Care Unit(ICU)residence time was significantly prolonged, 28 d mortality increased(P <0.01). Cox proportional hazard regression analysis showed that the increase of RDW values is an independent risk factor of death in patients with sepsis[odds ratio(OR)=1.0950, 95% confidence interval(95%CI)= 1.0536~1.1365, P <0.001]. Conclusion:The increase of initial RDW values were significantly associated with 28-day mortality in patients with septic shock.