红细胞分布宽度变化对脓毒症相关急性肾损伤发生的预测价值  

Predictive Value of Red Cell Distribution Width Variation in Occurrence of Sepsis-Associated Acute Kidney Injury

作　　者：高灵 张晓光[1] 李俊[1] 于荣国[1] 龚书榕[1] GAO Ling;ZHANG Xiaoguang;LI Jun;YU Rongguo;GONG Shurong(Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou 350001, China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院重症医学三科,福州350001

出　　处：《福建医科大学学报》2022年第2期136-142,共7页Journal of Fujian Medical University

摘　　要：目的探讨重症患者红细胞分布宽度(RDW)和RDW变化值(ΔRDW)与脓毒症相关急性肾损伤(AKI)的关系。方法回顾性纳入2016年1月—2018年8月符合Sepsis 3.0脓毒症诊断的患者159例。收集患者的一般资料,包括入院时的基础RDW、7 d内ΔRDW、相关辅助检查和最终结局。对脓毒症患者并发AKI的危险因素进行单因素及多因素logistic回归分析,比较各因素对脓毒症患者并发AKI的预测价值。结果(1)入院后7个24 h内ΔRDW≥1.30%组患者的AKI发生率较ΔRDW<1.30%组升高,差别有统计学意义(P<0.05)。(2)多因素logistic回归分析显示,在校正基础血肌酐、高血压病及糖尿病病史的情况下,ΔRDW与脓毒症患者并发AKI相关,基础肌酐值也对AKI存在影响。使用受试者工作曲线(ROC曲线)对各个指标的预测价值进行分析发现,ΔRDW对脓毒症患者并发AKI有中度预测价值,最佳预测值>1.45%。ΔRDW和PCT的联合指标对脓毒症患者并发AKI的预测价值优于单一指标。结论ΔRDW>1.45%对于预测脓毒症患者并发AKI有较好的临床价值。Objective To study the clinical value of red cell distribution width(RDW)and variation of RDW(ΔRDW)and their correlation with acute kidney injury(AKI)in patients with sepsis.Methods A retrospective study was performed in 159 cases with Sepsis 3.0 diagnosis admitted to Department of Surgical Critical Care Medicine of Fujian Provincial Hospital from January 2016 to August 2018.General information was collected on the patients,including basal RDW on admission,ΔRDW within 7 days and recording of relevant ancillary tests and final outcome of these patients.Univariate and multivariate logistic regression analyses were used to analyze the risk factors of sepsis-associated AKI and the predictive value of each factor for sepsis-associated AKI was compared.Results(1)The incidence of AKI in the group withΔRDW≥1.30%was significantly higher than that in the group withΔRDW<1.30%within 7 days after admission(P<0.05).(2)Multivariate logistic regression analysis revealed that after being adjusted by serum creatinine,high blood pressure and diabetes history,ΔRDW was associated with AKI in patients with sepsis,and baseline blood creatinine value also affected the development of AKI.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of the indicators for AKI.ΔRDW has a moderate predictive value for the occurrence of sepsis-associated AKI.The best predictive value ofΔRDW for sepsis-associated AKI was>1.45%.The predictive value of the combined index ofΔRDW plus PCT for sepsis-associated AKI was better than other single index.ConclusionΔRDW>1.45%may have a good predictive value for the occurrence of sepsis-associated AKI.

关 键 词：红细胞分布宽度 脓毒症 急性肾损伤 

分 类 号：R69[医药卫生—泌尿科学]