红细胞分布宽度预测急性呼吸困难患者30天病死率的价值研究

The value of red blood cell distribution width in predicting 30-day mortality in patients with acute dyspnea

目的 分析红细胞分布宽度(RDW)是否有助于预测急诊急性呼吸困难患者的早期病死率.方法 回顾性分析2018年1月至2018年10月收治的907例急性呼吸困难患者.主要临床结局为30 d病死率.结果 急性失代偿性心力衰竭(29.9%)是最常见的出院诊断,其次是癌症(14.8%)和肺炎(12.5%).30 d病死率风险从最低(RDW 12.9%)逐步增加到最高(RDW> 14.3%) RDW三分位数(1.4% vs.8.3%、18.3%,对数秩P<0.001).在多变量Cox风险分析中,校正其他风险因素后,RDW是30 d病死率的独立预测因子(HR 1.23,95%CI1.11~1.36,P<0.001).根据ROC曲线下的面积(AUC 0.873~0.885,P=0.023)和重分类改善指标(NRI=14.1%,P<0.001)/综合判别改善指数(IDI=0.038,P=0.006),在常规临床预测因子中加入RDW可显著改善30 d病死率的预测.结论 急诊入院检测的RDW是急性呼吸困难患者入院后30 d病死率的独立和附加预测因子.

Objective Red blood cell distribution width(RDW)can predict the clinical prognosis of cardiovascular diseases.The present study aims to analyze whether RDW is helpful in predicting early mortality in patients with acute dyspnea in emergency department(E D).Methods A total of 907 patients with acute dyspnea from January 2018 to October 2018 were retrospectively analyzed.The main clinical outcome was 30-day mortality.Results Acute decompensated heart failure(29.9%)was the most common discharge diagnosis,followed by cancer(14.8%)and pneumonia(12.5%).The 30-day mortality risk gradually increased from the lowest(RDW<12.9%)to the highest(RDW>14.3%)tertile 3 RDW(1.4%vs.8.3%,18.3%,Log rank P<0.001).In multivariate Cox risk analysis,RDW was an independent predictor of 30-day mortality after adjusting for other risk factors(HR 1.23,95%CI 1.11-1.36,P<0.001).According to the area under ROC curve(AUC from 0.873 to 0.885,P=0.023)and reclassification improvement index(NRI=14.1%,P<0.001)/comprehensive discriminant improvement index(IDI=0.038,P=0.006),adding RDW to routine clinical predictors can significantly improve the 30-day mortality prediction.Conclusion RDW detected at emergency admission is an independent and additional predictor of 30-day mortality in patients with acute dyspnea.