红细胞分布宽度在评估严重多发伤预后中的价值

The significance of red cell distribution width in treatment of severe multiple trauma

目的探讨红细胞分布宽度(red cell distribution width,RDW)和严重多发伤患者预后的关系。方法选取2018年10月1日至2019年4月1日浙江大学医学院附属第二医院和解放军第903医院两家创伤中心124例新入住ICU的严重多发伤患者。记录患者入科信息、第1、3、5天的RDW相关信息(D1RDW、D3RDW、D5RDW)、预后信息,根据出院是否存活,将患者分为存活组(n=102)和死亡组(n=22)。结果 RDW死亡组均较存活组明显升高,D1RDW[15.8(14.8,16.7)% 比 14.5(13.7,15.5)%,t=4.715,P<0.01]、D3RDW[17.0(15.0,17.7)% 比 13.8(13.6,14.9)%,t=7.571,P<0.01]、D5RDW[17.4(15.3,18.2)% 比 13.5(13.0,14.3)%,t=8.021,P<0.01]。不同组间RDW差异有统计学意义,死亡组RDW逐渐增加,而存活组RDW逐渐降低。入ICU后第1、3、5天的RDW对死亡的ROC曲线下面积分别为0.772,0.846,0.857,均显著>0.5(P均<0.01)。入ICU后第1、3、5天RDW对死亡预测的最佳临界点分别为15.6%、16.5%、15.3%。结论 RDW及其变化趋势能反映严重多发伤患者预后。

Objective To evaluate the relationship between red cell distribution width(RDW)and prognosis of patients with severe multiple injuries.Methods Data of 124 patients with severe multiple injuries admitted to 903RD Hospital of PLA and the Second Affiliated Hospital of Zhejiang University School of Medicine were assessed for the study.The admission information,RDW-related information including RDW on day 1(D1RDW),RDW on day 3(D3RDW)and RDW on day 5(D5RDW),as well as prognostic information were recorded.Patients were divided into survival group and death group.Results D1RDW of death group was significantly higher than that of survival group[15.8(14.8,16.7)v.s.14.5(13.7,15.5),t=4.715,P<0.01].D3RDW of death group was significantly higher than that of survival group[17.0(15.0,17.7)%v.s.13.8(13.6,14.9)%,t=7.571,P<0.01].D5RDW of death group was significantly higher than that of survival group[17.4(15.3,18.2)%v.s.13.5(13.0,14.3)%,t=8.021,P<0.01].The differences between the two groups were statistically significant.The RDW of the death group gradually increased,while the RDW of the survival group gradually decreased.The area under the ROC curve of RDW on day 1, day 3 and day 5 after ICU admission was 0.772, 0.846, and 0.857 with significantdifference (P < 0.01). The best critical points for RDW prediction of death on day 1, day 3, andday 5 after ICU admission were 15.6%, 16.5%, and 15.3%, respectively. Conclusion RDW and itsevolving trend can reflect the prognosis of patients with severe multiple injuries.