增高的红细胞分布宽度变化预测心源性休克患者预后  

Enlarging red cell distribution width during intensive care unit course for predicting prognosis in patients with cardiogenic shock

作　　者：袁瑶 黄娟 冯波 钟磊 YUAN Yao;HUANG Juan;FENG Bo(Department of Critical Care Medicine,The Second Hospital of Yinzhou Distitct,Ningbo 315100,China)

机构地区：[1]宁波市鄞州区第二医院重症医学科,浙江宁波315100 [2]湖州市中心医院重症医学科

出　　处：《全科医学临床与教育》2025年第4期315-319,共5页Clinical Education of General Practice

摘　　要：目的探讨重症医学科(ICU)住院期间红细胞分布宽度(RDW)变化(ΔRDW)及入ICU时RDW水平与心源性休克(CS)患者全因死亡率的关联。方法采用回顾性观察性队列研究方法,从美国重症监护医学信息数据库(MIMIC-Ⅲ)中收集首次入住ICU成人CS患者的临床资料。根据入ICU第1天时RDW水平将患者分为正常组(10.50%≤RDW≤15.50%)和高水平组(RDW>15.50%)。根据住院期间RDW变化情况又将其分为-0.40%<ΔRDW<0.40%组、ΔRDW≤-0.40%组和ΔRDW≥0.40%组。根据随访90 d时情况,将其分成生存组和死亡组,采用Kaplan-Meier生存曲线分析各组患者90 d累积生存率变化情况。运用多因素COX回归分析模型探索RDW是否为CS患者全因死亡率的独立危险因素。同时,采用限制性立方样条(RCS)刻画入ICU时RDW水平与死亡率之间的剂量反应关系。结果该项研究最终纳入770名成人CS患者,入ICU之日起90 d死亡316例,生存454例。与生存组相比,死亡组患者入住ICU时和离开ICU时RDW均较高。Kaplan-Meier生存曲线显示,与-0.40%<ΔRDW<0.40%组和ΔRDW≤-0.40%组相比,ΔRDW≥0.40%组CS患者90 d累积生存率最低(χ^(2)=15.58,P<0.05)。多因素COX回归分析显示,ΔRDW≥0.40%组和入ICU时高水平RDW组是90 d全因死亡率的独立危险因素(HR分别=1.58、1.49,P均<0.05)。RCS表明,入ICU第1天时RDW与CS患者90 d全因死亡间呈线性关系(χ^(2)=5.99,P>0.05)。结论入ICU时RDW水平≥14.99%及住ICU期间ΔRDW升高≥0.40%均与CS患者90 d全因死亡率相关。Objective To explore the association between the RDW variation(△RDW)during intensive care unit(ICU)course and the RDW on ICU admission and the risk of 90-day all-cause mortality in patients with cardiogenic shock(CS).Methods We employed retrospective observational cohort study and extracted clinical data about the adult CS patients on the first ICU admission from the MIMIC-Ⅲdatabase.According to RDW level on first day in ICU,the patients were divided into normal group(10.50%≤RDW≤15.50%)and high level group(RDW>15.50%).According to△RDW level during hospitalization,the patients were divided into-0.40%<ΔRDW<0.40%group,ΔRDW≤-0.40%group andΔRDW≥0.40%group,respectively.According to the situation at 90 days of follow-up,they were divided into survival group and death group.Kaplan-Meier survival curve was used to analyze the 90d cumulative survival rate of each group,and multivariate COX regression analysis was used to explore whether RDW was an independent risk factor for all-cause mortality in CS patients or not.At the same time,the dose-response relationship between RDW level and mortality on ICU admission was characterized by restricted cubic splines(RCS).Results The study included 770 adult patients with CS,of whom 316 died and 454 survived at 90 days after admission to ICU.Compared with CS patients in the survival group,RDW of patients in the death group was higher both on ICU admission and discharge.Kaplan-Meier survival curve showed that compared with the-0.40%<ΔRDW<0.40%group and theΔRDW≤-0.40%group,the 90d cumulative survival rate of CS patients in theΔRDW≥0.40%group was the lowest(χ^(2)=15.58,P<0.05).Multivariate COX regression analysis showed that the group withΔRDW≥0.40%and the group with high RDW on ICU admission were independent risk factors for 90d all-cause mortality(HR=1.58,1.49,P<0.05).RCS showed a linear relationship between RDW on first day of ICU admission and 90-day all-cause death in CS patients(χ^(2)=5.99,P>0.05).Conclusion An elevated RDW on ICU admission(≥14.99%)w

关 键 词：红细胞分布宽度 心源性休克 死亡率 重症医学科 队列研究 

分 类 号：R54[医药卫生—心血管疾病]