RDW对重症监护病房心力衰竭患者院内死亡的预测价值——基于MIMIC-Ⅲ数据库的回顾性研究

Predictive value of red blood cell distribution width for in-hospital mortality in ICU patients with heart failure:a retrospective study based on the MIMIC-Ⅲdatabase

目的 探讨红细胞体积分布宽度(RDW)预测重症监护病房(ICU)心力衰竭(HF)患者院内死亡的价值。方法 对2001—2012年重症监护医学信息数据库(MIMIC-Ⅲ)中被诊断为HF的成人患者(≥18岁)进行回顾性研究。采用受试者工作特征(ROC)曲线、多因素Logistic回归分析和净重新分类指数(NRI)分析RDW预测HF患者院内死亡的效能。结果 共纳入1 177例患者。校正潜在混杂因素后,分析结果显示,高RDW与HF患者院内死亡显著相关[比值比(OR)值为1.578,95%可信区间(CI)为1.019~2.445,P=0.041]。ROC曲线分析结果显示RDW预测ICU中HF患者院内死亡的曲线下面积(AUC)为0.633;与单独使用GWTG-HF比较,GWTG-HF与RDW联用的NRI为0.325,95%CI为0.056~0.623,P=0.021。结论 RDW可用于预测ICU中HF患者的院内死亡。RDW联合GWTG-HF可提高预测价值。

Objective To investigate the predictive value of red blood cell distribution width(RDW)for inhospital mortality in intensive care unit(ICU)patients with heart failure(HF).Methods A retrospective study was conducted on adult patients(≥18 years old)diagnosed with HF from 2001 to 2012 in the medical information mart for intensive care(MIMIC-Ⅲ)database.Receiver operating characteristic(ROC)curve,multivariate Logistic regression analysis and net reclassification index(NRI)were used to investigate the prognostic value of RDW.Results Totally,1177 patients who met the inclusion criteria were enrolled.After adjustment for potential confounders,high RDW was correlated with in-hospital mortality[odds ratio(OR)=1.578,95%confidence interval(CI)1.019-2.445,P=0.041].The area under curve(AUC)of RDW for predicting in-hospital mortality among HF patients in ICU was 0.633.Compared with GWTG-HF alone,the NRI of RDW combined with GWTG-HF was 0.325(95%CI 0.056-0.623,P=0.021).Conclusions RDW can be used to predict the in-hospital mortality of HF patients in ICU.RDW combined with GWTG-HF may increase the predictive value of in-hospital mortality.