红细胞分布宽度与危重症患者病死率的相关性研究

目的探讨危重症患者入重症监护室(intensive care unit,ICU)时红细胞分布宽度(red cell distribution width,RDW)与病死率的相关性。方法采用回顾性队列研究,纳入美国重症监护数据库Ⅱ版本2.6(Multiparameter Intelligent Monitoring in Intensive CareⅡversion 2.6,MIMIC-Ⅱv2.6)中单次入院且ICU住院时长> 24 h,同时有RDW检测记录的成年患者。根据RDW预测病死率的最佳cut-off值(14.55%)将研究对象分为低RDW组(RDW <14.55%)及高RDW组(RDW≥14.55%),比较两组的病死率,进一步使用单因素及多因素Logistic回归和Cox回归分析评估RDW与病死率的关系。结果本研究最终共有13 822例患者入组。高RDW组的医院病死率、ICU病死率、28 d病死率及1年病死率均高于低RDW组(分别为19.73%vs.8.42%,15.04%vs.6.65%,22.68%vs.9.12%,36.22%vs.14.45%,均P <0.001)。RDW作为连续变量,多因素分析结果显示,RDW越高,医院病死率(OR=1.227,95%CI 1.190~1.265)、ICU病死率(OR=1.180,95%CI 1.141~1.220)、28 d病死率(HR=1.161,95%CI 1.138~1.185)和1年病死率(HR=1.177,95%CI 1.159~1.195)越高。分组后回归分析结果显示,与低水平RDW组相比,高水平RDW组患者的医院病死率增加0.912倍(OR=1.912,95%CI 1.683~2.172),ICU病死率增加0.673倍(OR=1.673,95%CI 1.452~1.928),28 d病死率增加0.850倍(HR=1.850,95%CI 1.675~2.043),1年病死率增加1.045倍(HR=2.045,95%CI 1.891~2.212),且存在统计学意义(P <0.001)。结论入ICU首次RDW增高是危重症患者死亡的危险因素。

The relationship between red cell distribution width (RDW) and the mortality in critically ill patients

Objective To study the relationship between red cell distribution width( RDW) and the mortality in critically ill patients. Methods A retrospective cohort study was conducted for adult patients with complete RDW records and a single admission intensive care unit(ICU) and the stay length of ICU≥24 hours from the Multiparameter Intelligent Monitoring in Intensive Care Ⅱ version 2. 6.According to the optimum cut-off value of RDW predicting mortality( 14. 55%),the research objects were divided into two groups: low RDW( RDW < 14. 55%) and high RDW( RDW≥14. 55%). The mortalities were compared between the two groups,and univariate and multivariate Logistic regression models and Cox proportional hazards models were used to evaluate the relationship between RDW level and the mortality. Results A total of 13,822 patients were enrolled in this study. Compared with the low RDW group,the high RDW group had higher hospital mortality and ICU mortality,28-day and 1-year mortality( 19. 73% vs 8. 42%,15. 04% vs 6. 65%,22. 68% vs 9. 12%,36. 22% vs 14. 45%,respectively,P < 0. 001). The increasing RDW as continuous variable,was association with higher mortality after adjustment: hospital mortality( OR = 1. 227,95% CI 1. 190-1. 265),ICU mortality( OR = 1. 180,95% CI 1. 141-1. 220),28-day mortality( HR = 1. 161,95% CI 1. 138-1. 185),and 1-year mortality( HR = 1. 177,95% CI 1. 159-1. 195). Multivariate analysis after grouping indicated that the hospital mortality increased by 0. 912 fold( OR = 1. 912,95% CI 1. 683-2. 172),the ICU mortality by 0. 673 fold( OR = 1. 673,95% CI 1. 452-1. 928),the 28-day mortality by 0. 850 fold( HR = 1. 850,95% CI 1. 675-2. 043),and the 1-year mortality by 1. 045 fold( HR = 2. 045,95% CI 1. 891-2. 212) in the high RDW group compared with low RDW group. Conclusion The increase in first RDW is a risk factor for the mortality in critically ill patients.