红细胞分布宽度在慢加急性肝衰竭患者预后预测中的应用

目的 旨在探讨红细胞分布宽度（RDW）在慢加急性肝衰竭（ACLF）患者预测预后中的应用。方法 选取乙型肝炎病毒（HBV）相关性ACLF患者78例，根据预后分为生存及死亡组，检测患者外周血RDW水平及其他相关临床指标。结果 ACLF死亡患者外周血RDW水平高于生存患者（t=-3.568，P=0.004）。RDW与白细胞计数（WBC）、中性粒细胞绝对值/淋巴细胞绝对值（NLR）、总胆红素（TBIL）、终末期肝脏病评分（MELD）存在相关性（P值均<0.05）。受试者工作特征曲线（ROC）分析显示：RDW预测ACLF死亡率的ROC曲线下面积（AUC）为0.64，Cut off值为17.15%，灵敏度和特异度分别为54.2%和67.9%。多因素回归分析显示：RDW、NLR、国际标准化比值（INR）是ACLF患者短期死亡率的独立危险因素（OR值=1.444、1.305、1.891，P值均<0.05），生存分析显示：RDW≥17.15%患者生存率低于RDW＜17.15%患者（P<0.05）。结论 外周血RDW是临床预测ACLF患者短期预后的简单、有效的指标。

Application of red blood cell distribution width in the prognosis of acute on chronic liver failure

Objective To investigate the clinical value of red blood cell distribution width (RDW) in the prognosis of acute on chronic liver failure. Methods Totally 78 patients with hepatitis B related acute on chronic liver failure (ACLF) were enrolled and divided into survival and death groups according to their prognosis to detect RDW level and other related clinical indicators in this study. Results The RDW level in ACLF was significantly increased in non survivors than in survivors (t=-3.568, P=0.004). The level of RDW was correlated with WBC, NLR, TBIL, MELD scores (P<0.05). The area under the ROC curve (AUC) of RDW predicted mortality in ACLF was 0.64(0.52 0.77) at a cut off value of 17.15%, and the sensitivity and specificity were 54.2% and 67.9%, respectively. Multivariate regression analysis showed that RDW, NLR and INR were independent risk factors for short term mortality of patients with ACLF. High RDW level showed a significantly lower survival rate (P<0.05).Conclusion RDW is a simple and effective indicator that can predict the short term prognosis of ACLF.