出ICU时RDW水平对重症患者中长期预后的影响

The medium-term and long-term effect of ICU-discharge RDW level on prognosis of severe patients

目的分析出ICU时不同红细胞分布宽度(RDW)水平是否与重症患者出ICU后中长期预后的差异性相关。方法研究对象为重症监护医学信息(MIMIC)数据库中所有符合纳入标准的成年重症患者,研究变量为患者出ICU前24 h内最后1次RDW检测值,根据RDW水平进行分组,以患者出ICU后90 d死亡率为主要结局指标,365 d死亡率为次要结局指标。结果最终28004例患者纳入研究。RDW<13.8%组、RDW 13.8%~<15.2%组和RDW≥15.2%组患者出ICU后90 d死亡率分别为4.74%、8.67%、20.59%,差异有统计学意义(P<0.001);365 d死亡率分别为8.20%、14.92%、32.27%,差异有统计学意义(P<0.001)。Cox比例风险回归模型全因分析发现,出ICU时RDW水平是重症患者出ICU后90 d死亡率的重要预测指标:RDW 13.8%~<15.2%组HR=1.86,95%CI:1.65~2.09;RDW≥15.2%组HR=4.73,95%CI:4.25~5.26。经校正混杂因素后发现,出ICU时RDW水平仍然是独立预测患者出ICU后90 d死亡率的临床指标:RDW 13.8%~<15.2%组HR=1.28,95%CI:1.14~1.45;RDW≥15.2%组HR=2.51,95%CI:2.24~2.81;Cox比例风险回归模型分析365 d死亡率也得到相似的结论。受试者工作特征曲线及曲线下面积(AUC)评估发现出ICU时RDW水平对90 d死亡率有较好的预测功效,AUC为0.705,截断值为15.3%。结论出ICU时RDW水平可用于预测重症患者中长期预后。

Objective To investigate the association between different RDW levels at ICU discharge and the medium-term and long-term prognosis of severe patients after ICU discharge.Methods The study subjects were all adult severe patients who met the inclusion criteria in the MIMIC database.The study variables were the last RDW test value within 24 hours before the discharge from ICU.The patients were grouped according to RDW level.Mortality in 90 days after ICU discharge was the primary outcome,and mortality in 365 days was the secondary outcome.Results A total of 28004 patients were enrolled in the study.The 90 days mortality rates of RDW<13.8%,RDW 13.8%-<15.2%and RDW≥15.2%groups after ICU discharge were 4.74%,8.67%and 20.59%respectively,and the difference was statistically significant(P<0.001).The 365 days mortality rates were 8.20%,14.92%and 32.27%respectively,and the difference was statistically significant(P<0.001).All-cause analysis of Cox proportional hazard model analysis revealed that RDW level at ICU discharge was a significant predictor of 90 days mortality in severe patients after ICU discharge:RDW 13.8%-<15.2%group(HR=1.86,95%CI:1.65-2.09),RDW≥15.2%group(HR=4.73,95%CI:4.25-5.26).After adjusting for confounding factors,RDW level at ICU discharge remained a strong independent clinical predictor of mortality after 90 days:RDW 13.8%-<15.2%group(HR=1.28,95%CI:1.14-1.45),RDW≥15.2%group(HR=2.51,95%CI:2.24-2.81).Cox proportional hazard model analysis of 365 d mortality showed similar results.The ROC curve and area under the curve(AUC)evaluation showed that ICU-discharge RDW level had a good predictive effect on 90 d mortality,with AUC of 0.705 and cut-off value of 15.3%.Conclusion RDW level at ICU discharge can be used to predict medium-term and long-term prognosis of severe patients.