PDW/PLT、RDW/PLT与脓毒症并发急性呼吸窘迫综合征患者病情和预后的相关性分析

Correlation analysis of PDW/PLT,RDW/PLT and the condition and prognosis of patients with sepsis complicated by acute respiratory distress syndrome

目的探讨血小板分布宽度(PDW)/血小板计数(PLT)比值、红细胞分布宽度(RDW)/PLT比值与脓毒症并发急性呼吸窘迫综合征(ARDS)患者病情和预后的相关性。方法选择2018年1月—2020年9月绵阳市中心医院收治的脓毒症合并ARDS患者47例(ARDS组),脓毒症未并发ARDS患者101例(NARDS组)。根据氧合指数将ARDS组患者分为轻度亚组(201~300 mmHg,16例)、中度亚组(101~200 mmHg,20例)和重度亚组(≤100 mmHg,11例),根据入院后28 d内生存状况将ARDS组分为生存亚组(25例)、死亡亚组(22例)。检测2组PDW、RDW、PLT水平,计算PDW/PLT、RDW/PLT比值,分析PDW/PLT、RDW/PLT与脓毒症合并ARDS患者预后的关系,以及PDW/PLT、RDW/PLT预测脓毒症合并ARDS患者预后的价值。结果ARDS组PDW、RDW、PDW/PLT、RDW/PLT高于NARDS组(t/P=5.937/<0.001,4.749/<0.001,8.794/<0.001,7.963/<0.001),PLT显著低于NARDS组(t/P=5.048/<0.001)。PDW、RDW、PDW/PLT、RDW/PLT比较,重度亚组>中度亚组>轻度亚组(F=110.896、53.006、57.370、235.830,P均<0.001);PLT比较,重度亚组<中度亚组<轻度亚组(F/P=30.928/<0.001)。Logistic逐步回归分析结果显示,脓毒症休克、脏器衰竭个数≥2个、高APACHEⅡ评分、高PDW/PLT、高RDW/PLT是脓毒症合并ARDS患者入院28 d死亡的危险因素[OR(95%CI)=1.250(1.062~1.471),1.390(1.131~1.707),1.096(1.004~1.197),1.394(1.108~1.753),1.111(1.043~1.183)]。PDW/PLT、RDW/PLT预测脓毒症合并ARDS患者入院28 d死亡曲线下面积为0.791、0.784。结论脓毒症合并ARDS患者PDW/PLT、RDW/PLT均增加,高PDW/PLT、RDW/PLT与脓毒症合并ARDS病情加重及预后不良均有关。

Objective To explore the correlation between the ratio of platelet distribution width(PDW)/platelet count(PLT),red blood cell distribution width(RDW)/PLT ratio and the condition and prognosis of patients with sepsis complicated by acute respiratory distress syndrome(ARDS).Methods From January 2018 to September 2020,47 patients with sepsis complicated with ARDS(ARDS group)and 101 patients with sepsis without ARDS(NARDS group)were enrolled in Mianyang Central Hospital.According to oxygenation index,ARDS patients were divided into mild subgroup(201-300 mmHg,16 cases),moderate subgroup(101-200 mmHg,20 cases)and severe subgroup(≤100 mmHg,11 cases),and were divided into survival group(25 cases)and death group(22 cases)according to their survival status within 28 days after admission.PDW,RDW,PLT,PDW/PLT,RDW/PLT ratio were calculated to analyze the relationship between PDW/PLT,RDW/PLT and the prognosis of patients with sepsis complicated with ARDS,and the value of PDW/PLT,RDW/PLT in predicting the prognosis of patients with sepsis complicated with ARDS.Results PDW,RDW,PDW/PLT,RDW/PLT in ARDS group were higher than NARDS group(t/P=5.937/<0.001,4.749/<0.001,8.794/<0.001,7.963/<0.001),PLT was lower than NARDS group(t/P=5.048/<0.001).Comparison of PDW,RDW,PDW/PLT,RDW/PLT,severe subgroup>moderate subgroup>light subgroup(F=110.896,53.006,57.370,235.830,P<0.001).PLT comparison,severe subgroup<moderate subgroup<mild subgroup(F/P=30.928/<0.001).Logistic stepwise regression analysis showed that septic shock,the number of organ failures≥2,high APACHEⅡscore,high PDW/PLT,and high RDW/PLT are the risk factors for death of patients with sepsis and ARDS at 28 days after admission[OR(95%CI)=1.250(1.062-1.471),1.390(1.131-1.707),1.096(1.004-1.197),1.394(1.108-1.753),1.111(1.043-1.183)].PDW/PLT and RDW/PLT predicted that the area under the death curve of patients with sepsis and ARDS at 28 days after admission was 0.791 and 0.784.Conclusion The PDW/PLT and RDW/PLT are increased in patients with sepsis and ARDS.High PDW/PLT and RDW/PLT are related to the worsening of sepsis and ARDS and poor prognosis.