RDW/ALB值对COPD急性加重期患者临床预后的预测分析

Prediction Analysis of Clinical Prognosis of Patients with Acute Exacerbation Phase of Chronic Obstructive Pulmonary Disease by RDW/ALB Ratio

目的探讨红细胞分布宽度(RDW)与白蛋白(ALB)比值与慢性阻塞性肺疾病急性加重期(AECOPD)患者临床预后的关系。方法前瞻性队列研究,选择郑州市第一人民医院于2021年6月至2023年1月收治的146例AECOPD患者为研究对象,分析入院时RDW/ALB水平与临床预后的关系。检测并计算AECOPD患者入院次日RDW/ALB水平,设计基线资料调查表,采集患者性别、年龄、体重指数(BMI)、既往吸烟史、高血压史、糖尿病史、冠心病史及实验室指标等资料,采用logistic回归分析RDW/ALB值与AECOPD患者预后不良的关系,根据受试者工作特征(ROC)曲线评价RDW/ALB值对AECOPD患者预后的预测价值。结果所有患者RDW/ALB值为(1.19±0.21),根据四分位数将其分为Q1组(RDW/ALB≤1.04,37例)、Q2组(1.04<RDW/ALB≤1.16,38例)、Q3组(1.16<RDW/ALB≤1.29,35例)、Q4组(1.29<RDW/ALB≤1.98,36例);4组患者性别、BMI、既往吸烟史、高血压病史、糖尿病病史、冠心病病史、纤维蛋白原(Fib)、血清C反应蛋白(CRP)比较,差异无统计学意义(P>0.05);4组年龄、红细胞平均体积(MCV)值比较,差异有统计学意义(P<0.05);治疗后,有125例AECOPD患者预后良好,占比85.62%,有21例患者预后不良,占比14.38%,且4组预后不良患者例数随着RDW/ALB的增加而增加,分别为2.70%、7.89%、14.29%、33.33%(P<0.05);经单因素logistic回归分析显示,预后不良患者占比随RDW/ALB升高而增加,多因素logistic回归模型校正其他因素后,相对于Q1、Q2、Q3组,Q4组不良预后发生的危险度明显上升(OR>1,P<0.05);绘制ROC曲线,结果显示,RDW/ALB值预测AECOPD患者预后不良的曲线下面积(AUC)>0.7,具有一定的预测价值。结论RDW/ALB对AECOPD患者临床预后具有一定的预测价值,RDW/ALB值较高的患者临床不良预后发生风险高。

Objective To investigate the relationship between the ratio of red blood cell distribution width(RDW)to albumin(ALB)and the clinical prognosis of patients with acute exacerbation phase of chronic obstructive pulmonary disease(AECOPD).Methods A prospective cohort study was used in this study.A total of 146 patients with AECOPD admitted in the First People’s Hospital of Zhengzhou from June 2021 to January 2023 were selected as the study subjects,and the relationship between the level of RDW/ALB at admission and clinical prognosis was analyzed.RDW/ALB levels of patients with AECOPD on the next day after admission were detected and calculated.A baseline data questionnaire was designed,and data such as gender,age,body mass index(BMI),previous smoking history,hypertension history,diabetes history,coronary heart disease history and laboratory indicators were collected.Logistic regression was used to analyze the relationship between RDW/ALB value and poor prognosis of AECOPD patients,and the predictive value of RDW/ALB on prognosis of AECOPD patients was evaluated according to the receiver operating characteristic(ROC)curve of subjects.Results The RDW/ALB value of all patients was(1.19±0.21).According to the quartile,they were divided into Q1 group(RDW/ALB≤1.04,37 cases),Q2 group(1.04<RDW/ALB≤1.16,38 cases),Q3 group(1.16<RDW/ALB≤1.29,35 cases),Q4 group(1.29<RDW/ALB≤1.98,36 cases).There was no statistical difference in gender,BMI,smoking history,hypertension history,diabetes history,coronary heart disease history,fibrinogen(Fib),serum C-reactive protein(CRP)among the four groups(P>0.05).There were statistical differences in age and mean corpuscular volume(MCV)among the four groups(P<0.05).After treatment,125 patients with AECOPD had a good prognosis,accounting for 85.62%,and 21 patients had a poor prognosis,accounting for 14.38%.The number of patients with poor prognosis in the four groups increased with the increase of RDW/ALB,which was 2.70%,7.89%,14.29%,33.33%,respectively(P<0.05).Univariate logistic regression analysis showed that the proportion of patients with poor prognosis increased with the increase of RDW/ALB.After adjusting for other factors by multivariate logistic regression model,the risk of poor prognosis in group Q4 increased compared with groups Q1,Q2 and Q3(OR>1,P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of RDW/ALB value predicting the poor prognosis of AECOPD patients was more than 0.7,which had certain predictive value.Conclusion RDW/ALB has certain predictive value for the clinical prognosis of AECOPD patients,and the patients with higher RDW/ALB ratio have higher risk of adverse clinical prognosis.