心脏骤停患者红细胞分布宽度与神经功能预后的关系研究

Relationship between RDW and neurological function prognosis in patients with cardiac arrest

目的探讨红细胞分布宽度(red cell distribution width,RDW)对心脏骤停(cardiac arrest,CA)患者神经功能预后的预测价值。方法回顾性分析2020年1月至2023年11月笔者科室收治的107例CA患者的病例资料、RDW及生化指标,根据脑功能分类量表(cerebral performance category,CPC)评估患者的神经功能预后,将患者分为神经功能预后良好组和预后不良组,比较两组患者临床资料及RDW的组间差异。采用多因素Logistic回归分析影响CA患者神经功能预后的危险因素。受试者操作特征(receiver operating characteristic,ROC)曲线评估RDW对神经功能预后不良的效能,并确定最佳阈值,按RDW的最佳阈值分为高RDW组(≥13.45%)和低RDW组(<13.45%),比较两组患者神经功能预后不良的发生情况。结果共107例CA患者纳入分析,其中神经功能预后不良73例,预后良好34例,神经功能预后不良的发生率为68.22%。神经功能预后不良组的RDW、心肺复苏(cardiopulmonary resuscitation,CPR)时间、急性生理与慢性健康评分Ⅱ、年龄、丙氨酸转氨酶、血钠明显高于预后良好组(P<0.05)。多因素Logistic回归分析显示年龄、RDW、CPR时间是预测神经功能预后不良的独立危险因素(P<0.05)。RDW预测CA患者神经功能预后不良的曲线下面积为0.766,当RDW最佳阈值为13.45%时,敏感度为73%,特异性为71%。高RDW组患者的神经功能预后不良发生率为84.13%,明显高于低RDW组的45.45%,差异有统计学意义(P<0.05)。结论RDW升高是CA患者神经功能预后不良风险增加的独立危险因素,具有一定的预测价值。

Objective To investigate the prognostic value of red cell distribution width(RDW)on neurological prognosis in patients with cardiac arrest(CA).Methods Retrospective analysis the case data,RDW and biochemical indicators of 107 CA patients treated in our department(January 2020 to November 2023).According to cerebral performance category(CPC),patients were divided into good neurological prognosis group and bad neurological prognosis group.The differences in clinical data and RDW between the two groups were compared.Multivariate Logistic regression analysis was used to investigate the risk factors on neurological prognosis.Predictive effect of RDW on poor neurological prognosis in CA patients was assessed by receiver operating characteristic(ROC)curve.According to the optimal cut-off value of RDW,it was divided into high RDW group(≥13.45%)and low RDW group(<13.45%)to compare the incidence of poor neurological prognosis.Results Totally 107 CA patients were included,34 patients in the good neurological prognosis group and 73 patients in the bad neurological prognosis group,the incidence of poor prognosis of neurological function was 68.22%.Compared with good neurological prognosis group,the acute physiology and chronic health evaluation II score,RDW,cardiopulmonary resuscitation(CPR)time,age,serum sodium and glutamic-pyruvic transaminase in bad neurological prognosis group were significantly increased(P<0.05).Multivariate Logistic regression analysis showed that RDW,age and CPR time were independent risk factors for poor prognosis of neurological function(P<0.05).ROC curve analysis showed that the area under the curve of RDW to predict poor neural function prognosis in CA patients was 0.766.When the optimal threshold of RDW was 13.45%,the sensitivity was 73%and the specificity was 71%.The incidence of poor prognosis of neurological function in high RDW group was 84.13%,which was significantly higher than 45.45%in low RDW group(P<0.05).Conclusion Elevated RDW is an independent risk factor for increased risk of poor neurological outcomes in patients with CA.It has certain predictive value for neurological outcomes in patients with CA.