红细胞分布宽度与白蛋白比值对心源性休克患者预后评估的价值

Association between red cell distribution width to albumin ratio and the prognosis of cardiogenic shock patients

目的探讨红细胞分布宽度(RDW)与白蛋白比值(RAR)对成人心源性休克(CS)患者预后的评估价值。方法回顾2008—2019年美国重症监护医学信息数据库(MIMIC-IV)中的933例成年CS患者临床资料。依据住院期间预后情况,将患者分为存活组608例和死亡组325例;依据RAR值三分位数将患者分成<4.30组309例、4.30~5.34组313例和>5.34组311例。应用Kaplan-Meier法绘制3组间患者住院期间生存曲线,并建立Cox回归模型以分析RAR与CS患者临床结局间的关系。结果死亡组患者年龄、序贯器官衰竭估计评分、RDW、RAR、阴离子间隙、肌酐及FPG值、合并急性肾损伤、心搏骤停、肝硬化、慢性肾脏病和慢性阻塞性肺疾病比例均高于存活组,死亡组白蛋白、RBC值、高血压比例均低于存活组,总住院时间短于存活组(均P<0.05)。Kaplan-Meier生存曲线显示,3组CS患者住院期间累积生存率比较差异有统计学意义(χ^(2)=15.600,P<0.01)。多因素Cox回归分析显示,入ICU时RAR值较高(>5.34)是CS患者住院期间(HR=1.374,95%CI:1.022~1.847)死亡的独立危险因素。结论RAR升高(>5.34)与成人CS患者预后不良间密切相关,有助于临床医务工作者对其预后情况进行评估。

Objective To explore the value of red cell distribution width(RDW)to albumin ratio(RAR)at admission to the intensive care unit(ICU)in predicting the prognosis of adult patients with cardiogenic shock(CS).Methods The clinical data of 933 adult patients with CS were collected from the Multiparameter Intelligent Monitoring in Intensive Care IV database from 2008 to 2019.Patients were divided into the survival group(n=608)and death group(n=325)based on the outcomes during hospitalization.According to the tertiles of RAR levels there were 309 cases in low RAR group(<4.30),313 case in medium RAR group(4.30-5.34)and 311 cases in high RAR group(>5.34).Kaplan-Meier method was applied to plot cumulative survival curve of patients during hospitalization.The Cox regression model was established to analyze the relationship between RAR and the clinical outcomes of CS patients.Results Compared with the survival group,the death group had significantly higher age,SOFA score,RDW,RAR,anion gap,creatinine and glucose,and higher proportion of acute kidney injury,cardiac arrest,cirrhosis,chronic kidney disease and chronic obstructive pulmonary disease.Whereas,the levels of albumin and red blood cell,the proportion of patients with hypertension in the death group were lower,and the length of hospital stay was shorter than those in the survival group(all P<0.05).There was significant difference in the cumulative survival rate during hospitalization among CS patients in different RAR groups(P<0.01).The multivariate Cox regression analysis showed that high RAR(>5.34)was an independent risk factor for all-cause mortality of CS patients during hospitalization (HR=1.374, 95%CI:1.022-1.847). Conclusion Elevated RAR level (>5.34) is closely associated with the poorprognosis of adult patients with cardiogenic shock.