红细胞分布宽度与心搏骤停患者预后的回顾性队列研究

Red cell distribution width and prognosis in patients with cardiac arrest:A retrospective cohort study

目的探讨入住ICU时的红细胞分布宽度(red cell distribution width,RDW)与心搏骤停(cardiac arrest,CA)患者全因病死率的关系。方法本研究是一项回顾性队列研究(2001—2012年),从美国重症监护医学信息数据库(MIMIC-Ⅲ,v1.4)中提取首次入住ICU的成人(年龄≥18岁)CA患者的临床资料。按照90 d是否死亡进行分组,将所有患者分为生存组和死亡组,并比较两组临床特征。同时,按照四分位数间距法将RDW分成四组。采用Kaplan-Meier生存曲线分析各组患者28 d和90 d累积生存率变化情况,并采用log-rank检验加以检验。运用多因素Cox回归分析揭示RDW和CA患者全因病死率之间的关系。结果依据纳入排除标准,最终纳入853例成人CA患者。整体人群年龄(67.26±15.84)岁,男性为534例(62.60%),SOFA评分(6.13±3.70)分。与存活组(n=410)比较,死亡组(n=443)患者年龄、SOFA评分、RDW、阴离子间隙、肌酐以及血磷值较高,慢性阻塞性肺疾病、急性肾损伤和脓毒症的比例较高,ICU住院时间较长;而动脉血氧分压、血红蛋白以及血总钙值较低,冠心病和急性心肌梗死的比例较低,总住院时间较短,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线显示,不同RDW分组CA患者28 d和90 d累积生存率不同,差异均具有统计学意义(均P<0.001)。多因素Cox回归分析表明入ICU时RDW升高是CA患者28 d全因病死率(HR=1.399,95%CI:1.014~1.930,P=0.041)和90 d全因病死率(HR=1.433,95%CI:1.064~1.929,P=0.018)的独立危险因素。结论RDW升高是CA患者28 d和90 d全因病死率的独立预测因子,可作为一种临床指标来预测CA患者不良预后。

Objective To investigate the association between the initial red cell distribution width(RDW)and all-cause mortality in patients with cardiac arrest(CA)in intensive care unit(ICU).Methods We conducted a retrospective cohort study and extracted the related clinical data in ICU among adult CA patients(age≥18 years),using the Multiparameter Intelligent Monitoring Intensive Care III(MIMIC-Ⅲ,v1.4)database from 2001 to 2012.Based on whether they survived or not on 90 days,the patients were divided into the survival group and death group,and the clinical data of the two groups were compared.Meanwhile,the RDW values were divided into four parts according to quartile.The cumulative survival rate of 28-day and 90-day were estimated using the Kaplan-Meier method and compared using the log-rank test.Multivariate Cox proportional hazard models were also used to reveal the association between RDW and all-cause mortality.Results Based on the inclusion and exclusion criteria,853 adult CA patients were finally enrolled.The mean age was(67.26±15.84)years,and 534(62.60%)patients were male.And the mean SOFA score was(6.13±3.70).Compared with the survival group(n=410),the patients in the death group(n=443)were older and had a higher SOFA score,RDW,anion gap,creatinine and blood phosphorus.Moreover,the proportion of chronic obstructive pulmonary disease,acute kidney injury and sepsis in the death group were higher than those in the survival group,and the length of stay in ICU in the death group was longer than that in the survival group(all P<0.05).However,the indicators of arterial blood oxygen partial pressure,hemoglobin and total blood calcium,as well as the proportion of coronary heart disease and acute myocardial infarction were lower than those in the survival group,and a shorter duration of hospitalization in the death group was noted(all P<0.05).Kaplan-Meier survival curves demonstrated that there was a significant difference in the cumulative survival rate of 28-day and 90-day(all P<0.001).In the multivariate Cox proportional hazard models,a higher RDW at ICU admission was an independent risk factor for 28-day(HR=1.399,95%CI:1.014-1.930,P=0.041)and 90-day(HR=1.433,95%CI:1.064-1.929,P=0.018)all-cause mortality among CA patients.Conclusions An elevated RDW is an independent predictor for 28-day and 90-day all-cause mortality of CA patients.As a clinical indicators,it indicates a poor prognosis for adult CA patients.