基于数据挖掘评估红细胞分布宽度对脓毒症患者预后的影响

Evaluation of the influence of red blood cell distribution width on the prognosis of patients with sepsis based on data mining

目的:探讨红细胞分布宽度(RDW)对脓毒症患者预后的影响。方法:采用重症监护医学信息市场(MIMIC-Ⅲ)数据库作为数据来源,根据2016年《脓毒症与脓毒性休克国际处理指南》中脓毒症诊断标准提取MIMIC-Ⅲ数据库中的脓毒症患者,根据预后将患者分为存活组和死亡组。收集患者一般资料,以序贯性脏器功能衰竭评分(SOFA)进行评价,记录患者脓毒性休克发生率及转归情况。结果:共纳入11 691例脓毒症患者,28 d病死率为11.9%。与死亡组相比,存活组患者更年轻,较少合并慢性心衰及COPD,脓毒性休克的发生率低,具有较低的SOFA及RDW水平,行CRRT及机械通气的比例均明显较低,ICU停留时间明显缩短(P<0.001)。Cox比例风险回归分析结果提示RDW是脓毒症患者死亡的独立危险因素(OR=1.068 6;95%CI:1.047 1～1.090 5,P<0.001)。结论:初始RDW值与脓毒症患者28 d病死率显著相关。

Objective:To explore the effect of red blood cell distribution width(RDW) on the prognosis of patients with sepsis. Method:We used Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ) database as data source.The patients with sepsis in the MIMIC-Ⅲ database were extracted according to the diagnostic criteria for sepsis in International Guidelines for Management of Sepsis and Septic Shock: 2016. According to the prognosis, patients were divided into survival group and death group.General data of patients was collected and evaluated by sequential organ failure score(SOFA), and the incidence of septic shock and the prognosis were recorded. Result:A total number of 11 691 patients with sepsis were included. The 28-day mortality was 11.9%. Compared with the death group, the patients were younger in the survival group, with less complications of chronic heart failure and chronic obstructive pulmonary disease(COPD),lower incidence of septic shock, lower SOFA score and RDW level, significantly lower proportion of continuous renal replacement therapy(CRRT) and mechanical ventilation, and significantly shortened intensive care unit(ICU) residence time(P<0.01).Cox proportional hazard regression analysis showed that RDW is an independent risk factor of death in patients with sepsis (odds ratio(OR)=1.068 6,95% confidence interval(95%CI):1.047 1-1.090 5,P<0.001)Conclusion:Initial RDW values were significantly associated with 28-day mortality in patients with sepsis.