红细胞分布宽度对呼吸机相关性肺炎患者预后的预测价值

Predictive value of red cell distribution width in the prognosis of patients with ventilator-associated pneumonia

目的本研究旨在评估入重症医学科(ICU)时红细胞分布宽度(RDW)对呼吸机相关性肺炎(VAP)患者预后的预测价值。方法采用回顾性队列研究方法,所有数据均来自MIMIC-Ⅲ(v1.4)数据库。本研究纳入所有首次入住ICU的成人VAP患者(≥18岁),采用三分位数法将RDW值分成3组。比较3组间VAP患者临床特征,运用KM法绘制VAP患者90 d和360 d累积生存率曲线。运用Cox回归风险模型以探索VAP患者全因死亡率的独立危险因素。结果本研究共有437例成人VAP患者符合研究标准。年龄、RDW、序贯器官衰竭估计评分、动脉血氧分压、血小板、肌酐、国际标准化比值、高血压、充血性心力衰竭、慢性阻塞性肺疾病、90 d和360 d全因死亡率等指标有统计学意义(P<0.05)。KM生存曲线显示,3组VAP患者90 d和360 d累积生存率不同,log-rank检验显示差异有统计学意义(χ^(2)_(1)=8.820,χ^(2)_(2)=15.190,P=0.001)。多因素Cox回归风险模型表明,RDW水平上升(≥15.30%)是影响VAP患者90 d(HR=1.697,95%CI:1.034~2.784,P=0.036)和360 d(HR=1.921,95%CI:1.236~2.987,P=0.004)全因死亡率的独立危险因素。结论升高的RDW(≥15.30%)与VAP患者90 d和360 d全因死亡率相关,在评估VAP患者不良预后方面具有一定的临床价值。早日识别高危人群,提前做好护理治疗,从而预防VAP的发生。

Objective This study is to assess the prognostic value of red cell distribution width(RDW)after admission to intensive care unit(ICU)in patients who experienced ventilator-associated pneumonia(VAP).Methods We carried out a retrospective cohort study on the basis of the Medical Information Mart for Intensive CareⅢ(MIMIC-Ⅲv1.4)database.Adult VAP patients(≥18 years old)admitted to ICU for the first time were eligible for this study.Participants were grouped by tertiles of RDW value.The clinical characteristics were compared on these three groups.The 90 d and 360 d cumulative survival rates were made by using Kaplan-Meier method.The independent predictor of all-cause mortality among VAP patients was conducted using the Cox proportional hazard regression model.Results Four hundred and thirty-seven adult VAP participants met the study criteria.The age,RDW,SOFA score,arterial partial pressure of oxygen,platelet,creatinine,international normalized ratio,hypertension,congestive heart failure,chronic obstructive pulmonary disease,90 d and 360 d all-cause mortality were significantly different across the three RDW tertile(P<0.05).KM survival curve showed that the cumulative survival rates of VAP patients in the three groups were different in 90 d and 360 d,and log-rank test showed statistical significance in the differences(χ^(2)_(1)=8.820,χ^(2)_(2)=15.190,P=0.001).In the Cox proportional hazard models,the highest RDW tertile(≥15.30%)was associated with an independent risk factor for 90 d(HR=1.697,95%CI:1.034-2.784,P=0.036)and 360 d(HR=1.921,95%CI:1.236-2.987,P=0.004)all-cause mortality among VAP patients.Conclusion An elevated level of RDW(≥15.30%)is related to the 90 d and 360 d all-cause mortality in VAP patients.It has certain clinical value in assessing the poor prognosis of these patients.We need to identify high-risk group as soon as possible,and make proper care in advance.Therefore,the occurrence of VAP is prevented.