尿酸联合红细胞分布宽度对脓毒症患者短期结局的预测价值

目的探讨尿酸联合红细胞分布宽度（RDW）在评估脓毒症患者短期临床预后中的诊断价值。 方法将216例脓毒症患者根据尿酸及RDW水平分为A组（尿酸≤ 258 μmol/L且RDW ≤ 14.1%，50例）、B组（尿酸≤ 258 μmol/L且RDW>14.1%，58例）、C组（尿酸>258 μmol/L且RDW ≤ 14.1%，58例）、D组（尿酸>258 μmol/L且RDW>14.1%，50例）。对各组患者的住院期间病死率、30 d病死率、尿酸及RDW进行比较；同时，应用Kaplan-Meier生存曲线比较各组患者随访30 d生存曲线变化；应用受试者工作特征（ROC）曲线判断尿酸、RDW及二者联合指标对脓毒症患者住院期间及随访30 d死亡风险的预测价值。 结果4组患者间住院期间病死率、30 d病死率、尿酸及RDW间比较，差异均有统计学意义（F= 16.211、19.206、132.755、59.771，P均<0.05）。进一步两两比较发现，住院期间病死率仅D组显著高于A组40.00%（20/50）vs. 8.00%（4/50），P<0.008]，且与C组及D组比较，A组的30 d病死率34.48%（20/58）、52.00%（26/50）、12.00%（6/50），P均<0.008]及A组与B组的尿酸水平（411 ± 115）、（412 ± 117）、（170 ± 61）、（148 ± 66）μmol/L，P均<0.05]均显著较低；同时，B组与D组的RDW均显著高于A组与C组（15.9 ± 2.0）%、（16.0 ± 2.1）%、（13.3 ± 0.6）%、（13.2 ± 0.6）%，P均< 0.05]。而C组与D组间住院期间病死率（P>0.008）、30 d病死率（P>0.008）及尿酸水平（P>0.05）的比较，差异均无统计学意义。4组患者间的Kaplan-Meier生存曲线比较，差异有统计学意义（χ²= 14.102，P= 0.003），且C组及D组的生存曲线均显著低于A组（P均<0.008）。ROC曲线显示，尿酸联合RDW对脓毒症患者住院期间及随访30 d死亡风险的预测价值均明显优于尿酸（Z= 2.043，P= 0.041；Z= 2.012，P= 0.044）及RDW（Z= 2.245，P= 0.025；Z= 2.322，P= 0.020）。 结论尿酸联合RDW能较好地预测脓毒症患者短期临床结局。

Prognostic value of uric acid combined with red cell distribution width for short-term outcomes in patients with sepsis

ObjectiveTo investigate the prognostic significance of uric acid combined with red cell distribution width (RDW) for short-term outcomes in patients with sepsis. MethodsAccording to the levels of uric acid and RDW, 216 patients with sepsis were divided into 4 groups: group A (uric acid ≤ 258 μmol/L and RDW ≤ 14.1%, 50 cases), group B (uric acid ≤ 258 μmol/L and RDW>14.1%, 58 cases), group C (uric acid>258 μmol/L and RDW ≤ 14.1%, 58 cases) and group D (uric acid>258 μmol/L and RDW>14.1%, 50 cases). The in-hospital and 30-day mortality rates, and the levels of uric acid and RDW were compared among the 4 groups. Meanwhile, the Kaplan-Meier survival analysis was used to estimate the 30-day survival in each group. The receiver operating characteristic (ROC) curve was used to describe the predictive value of uric acid, RDW and their combined indices for in-hospital and 30-day mortality rates. ResultsThe in-hospital and 30-day mortality rates, and the levels of uric acid and RDW were significantly different among the 4 groups (F= 16.211, 19.206, 132.755, 59.771; all P<0.05). Furthermore, the in-hospital mortality rate in the group D was higher than that in the group A 40.00% (20/50) vs. 8.00% (4/50), P<0.008]. The 30-day mortality rate in the group A 34.48% (20/58), 52.00% (26/50), 12.00% (6/50); both P<0.008] and the uric acid level in the group A and group B (411 ± 115), (412 ± 117), (170 ± 61), (148 ± 66) μmol/L; all P<0.05] decreased markedly as compared with the group C and group D. The RDW in the group B and group D was much higher than that in the group A and group C (15.9 ± 2.0)%, (16.0 ± 2.1)%, (13.3 ± 0.6)%, (13.2 ± 0.6)%; all P<0.05]. However, the in-hospital and 30-day mortality rates (both P>0.008), and the uric acid level (P>0.05) all showed no significant differences between the group C and group D. The Kaplan-Meier survival analysis showed that the curves of 4 groups were statistically significantly different (χ²= 14.102, P= 0.003), and the curves of group C and group D were much lower than that of group A (both P<0.008). The ROC curve indicated that uric acid combined with RDW was much better than uric acid (Z= 2.043, P= 0.041; Z= 2.012, P= 0.044) and RDW (Z= 2.245, P= 0.025; Z= 2.322, P= 0.020) alone in the predictive value for in-hospital and 30-day mortality rates in patients with sepsis. ConclusionUric acid combined with RDW can better predict short-term clinical outcomes in patients with sepsis.