红细胞分布宽度联合毛细血管渗漏指数对脓毒症并发急性呼吸窘迫综合征的预后评估价值

Prognostic evaluation value of red blood cell distribution width(RDW)and C-reactive protein/albumin ratio(CLI)in sepsis patients complicated with acute respirator distress syndrome

目的探讨红细胞分布宽度(RDW)联合毛细血管渗漏指数(CLI)对脓毒症并发急性呼吸窘迫综合征(ARDS)预后的评估价值。方法回顾性分析2017年10月~2019年12月期间我院收治的脓毒症并发ARDS患者,根据患者28天预后情况分为死亡组和存活组,收集性别、年龄、血清白蛋白、CRP、红细胞分布宽度、氧合指数值,计算APACHEⅡ评分、SOFA评分、毛细血管渗漏指数。结果存活组与死亡组比较,性别、SOFA评分差异无统计学意义(P>0.05);年龄、RDW、CLI、氧合指数、APACHEⅡ评分差异有统计学意义(P=0.002;P=0.031;P=0.041;P=0.048;P=0.005)。Spearman相关分析结果显示RDW与APACHEⅡ评分呈显著正相关(rs=0.314,P<0.001),RDW与氧合指数呈显著负相关(rs=-0.720,P<0.001);联合变量(RDW+CLI)的AUC曲线下面积值最大,为0.651,其次是APACHEⅡ评分,为0.647,RDW的AUC值是0.646,CLI的AUC值是0.601。RDW为46.55作为临床诊断界值时,预测ARDS死亡的敏感度和特异度分别为57.8%和71%,CLI为5.87作为临床诊断界值时,预测ARDS死亡的敏感度和特异度分别为53.3%和77.4%,联合预测的敏感度和特异度分别为62.2%和67.7%。结论RDW联合CLI对脓毒症并发ARDS患者的预后具有一定的评估价值。

Objective To explore the prognostic evaluation value of red blood cell distribution width(RDW)and C-reactive protein/albumin ratio(CLI)in sepsis patients complicated with acute respirator distress syndrome(ARDS).Methods Retrospective analysis was conducted on sepsis patients complicated with ARDS in Anqing municipal hospital from October 2017 to December 2019.They were divided into the survival group and the death group according to their 28d prognosis.Age,sex,serum albumin,CRP,RDW,and oxygenation index were collected and tested.APACHEⅡscore,SOFA score and CLI were calculated.Results There was no significant difference in sex and SOFA score between the two groups(P>0.05).Age,RDW,CLI,oxygenation index,and APACHEⅡscore in the death group were significantly higher than those in the survival group(P=0.002;P=0.031;P=0.041;P=0.005).Oppositely,oxygenation index was higher in the survival group than in the death group(P=0.048).Spearman correlation analysis showed that RDW and APACHEⅡscore had significantly positive correlation(rs=0.314,P<0.001).RDW and oxygenation index was negatively correlated(rs=-0.720,P<0.001).In the ROC curve analysis of AUC,joint variable(RDW and CLI)had the largest AUC value(AUC=0.651),followed by APACHEⅡscore(AUC=0.647),RDW(AUC=0.646),CLI(AUC=0.601).When RDW was 46.55 as the clinical diagnosis boundary value,the sensitivity and specificity of predicting death were 57.8%and 71%.When CLI was 5.87 as the clinical diagnosis boundary value,the sensitivity and specificity of predicting death were 53.3%and 77.4%.When joint variable(RDW and CLI)as the clinical diagnosis boundary value,the sensitivity and specificity of predicting death were 62.2%and 67.7%.Conclusion RDW and CLI have particular value in judging the prognosis of sepsis patients complicated with ARDS.