动态检测红细胞分布宽度评估脓毒症预后的价值  

Prognostic value of dynamic determination of red cell distribution width concentrations for sepsis：aretrospective study

作　　者：郑金浩 刁孟元[1] 单怡[1] 赵良[1] 林兆奋[1] 

机构地区：[1]第二军医大学附属长征医院急救科,上海200003

出　　处：《中国急救医学》2015年第5期390-393,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：国家自然基金项目（81201445）

摘　　要：目的：探讨动态检测红细胞分布宽度（ red cell distribution width， RDW）对脓毒症预后的评估价值。方法回顾性分析2012－01～2013－12入住长征医院急救科脓毒症患者的临床资料，检测入院24 h内（D1）、第3天（D3）、第5天（D5）及第7天（D7）RDW，分别计算D3、D5及D7与D1的RDW差值（ΔD3、ΔD5、ΔD7），按照预后分组进行统计学分析。采用Logistic回归寻找影响预后的独立危险因素，绘制ROC曲线，计算各指标的曲线下面积并比较各指标评估脓毒症预后的敏感度和特异度。结果共纳入161例脓毒症患者，其中存活组126例，死亡组35例。存活组的ΔRDW高于死亡组（P＜0．01）。多因素Logistic回归提示，ΔD7为影响预后的独立危险因素（OR＝0．58，95％CI 0．352～0．946，P＝0．029）。 ROC曲线提示，ΔD7对脓毒症患者预后评估效能与SOFA评分、APACHEⅡ评分相当，ROC曲线下面积（AUC）0．807、0．802、0．810，ΔD7敏感度优于两评分（0．71、0．62、0．65）。结论动态检测RDW可用于评估脓毒症患者的预后，入院1周时的预测情况较好。Objective To investigate the prognostic value of dynamic determination of red cell distribution width （ RDW） in sepsic patients.Methods A total of 161 Patients were selected and recorded in ICU department in Shanghai Changzheng Hospital from January of 2012 to December of 2013.RDW concentrations on Day 1（D1）, Day 3（D3）, Day 5（D5）and Day 7（D7）were recorded, andΔD3（D3-D1）, ΔD5（D5 -D1）, ΔD7（D7 -D1） were calculated.They were divided into two groups by different outcome.ΔRDW were compared between two groups.In addition, Logistic regression analysis was performed to determine the risk factors for mortality.ΔRDW, APACHEⅡscore and SOFA score were evaluated using receiver operating characteristic curve （ ROC ） .Results Among the 161 included sepsis patients, 126 cases were survivors and the other 35 cases were non-survivors.Non-survivors had a higher level of ΔRDW than survivors （P〈0.01）.Higher ΔRDW was associated with higher mortality.ΔD7 was an independent risk factor for mortality（OR=0.58, 95%CI 0.352~0.946, P=0.029）.Estimating the receiver operating characteristic area under the curve shows that ΔD7, APACHEⅡ score and SOFA score can evaluate sepsis patients prognosis as the same （ AUC 0.807, 0.802, 0.810;P〈0.001） .Sensitivity ofΔD7 was higher than two kinds of scores system.Conclusion Dynamic determination of RDW can evaluatethe prognosis of sepsis patients.It shows a very good prognosis prediction for sepsis within one week after admission.

关 键 词：红细胞分布宽度(RDW) 脓毒症 预后 

分 类 号：R556[医药卫生—血液循环系统疾病]