红细胞分布宽度及其动态变化在评估重症急性胰腺炎患者预后中的价值

目的:探讨重症急性胰腺炎患者血清红细胞分布宽度(RDW)水平以及其动态变化对其病情预后的评估价值?方法:回顾性分析2012年1月至2016年1月皖南医学院附属弋矶山医院重症医学科收治的72例重症急性胰腺炎患者资料?比较生存组(n=51)?死亡组(n=21)患者入住重症医学科第1天APHACH Ⅱ评分?SOFA评分?RDW(RDWd1)?降钙素原?白细胞?红细胞?血红蛋白?血淀粉酶?白蛋白?C-反应蛋白水平差异;并根据RDWd1水平,以及第3天与第1天RDW水平的差值(RDWd3-d1)是否超过0.2%将患者分为4组?以90 d病死率为结局事件,应用Kaplan-Meier曲线分析4组患者死亡的累积概率,Log-rank检验评价组间差异?结果:重症胰腺炎患者入重症医学科后第1天的APACHE Ⅱ评分?SOFA评分?RDWd1?降钙素原水平,死亡组均高于生存组(P < 0.001);多因素Logistic回归分析显示:高龄和RDWd1是预测SAP患者死亡的独立危险因素,OR值分别为6.257(95%CI:1.539~25.440,P=0.010)和2.554(95%CI:1.218~5.353,P=0.013);RDWd1判断患者死亡预后的最佳临界值为14.8(ROC曲线下面积为0.773,95%CI:0.652~0.893,P < 0.001);RDWd1超过正常范围,且RDWd3-d1>0.2%时,SAP患者死亡风险最高(P=0.023)?结论:RDW基线水平及其早期动态增高可能是评估重症急性胰腺炎患者预后的简单有效指标?

Dynamic evolution of red blood cell distribution width level in predicting prognosis in patients with severe acute pancreatitis

Objective:To assess the predictive value of the red blood cell distribution width(RDW) in evaluation of prognosis in severe acute pancreatitis patients. Methods:From January 2014 to January 2016,a total of 72 patients with severe acute pancreatitis were retrospectively analyzed. Comparisons for APHACH II score,SOFA score,RDW(RDWd1),procalcitonin,white blood cells,red blood cells,hemoglobin,serum amylase,albumin and C-reactive protein,which obtained at the first day after admission to ICU,were performed between survivors and non-survivors. The patients were divided into four groups according to RDWd1 value and RDWd3-d1(RDW at the third day-RDWd1). The Kaplan-Meier curve was used to evaluate the prognostic value of dynamic evolution of RDW for 90-days mortality. Log-rank test was performed to evaluate difference between groups. Results:Levels of APHACH II score,SOFA score,RDWd1 and procalcitonin on the first day were significantly higher in non-survivors(P < 0.001). In the univariate model,advanced age and RDWd1 were the independent risk factors of prognosis in SAP patients(OR=6.257,95%CI:1.539~25.440,P=0.010,and OR=2.554,95%CI:1.218~5.353,P=0.013). The optimal cut-off value of RDWd1 for predicting 90-days mortality was 14.8(the area under the ROC curve was 0.773,95%CI:0.652~0.893,P < 0.001). Patients with increased RDWd1 and RDWd3-d1>0.2% exhibited the highest risks for mortality(P=0.023). Conclusion:RDW and itself early dynamic elevation can be potential independent prognostic markers in patients with severe acute pancreatitis.