Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Am J Med. 2012 Mar;125(3):283-91. doi: 10.1016/j.amjmed.2011.08.021.
Previous studies suggest that red cell distribution width, a measure of erythrocyte size variability, may predict long-term mortality, particularly in cardiovascular disease. Less research has focused on the prognostic utility of red cell distribution width in an acutely hospitalized population.
We performed a secondary analysis of prospectively collected data on 74,784 consecutive hospitalized adults with red cell distribution width measured on admission. The primary outcome of interest was in-hospital mortality; a secondary outcome was unplanned transfer to the intensive care unit. We calculated multivariable logistic models adjusted for age, gender, race, and comorbid conditions.
The overall in-hospital mortality rate was 1.3% (95% confidence interval [CI], 1.2-1.4). As red cell distribution width increased, so did mortality, from 0.2% (lowest red cell distribution width decile) to 4.4% (highest red cell distribution width decile). Unadjusted red cell distribution width significantly discriminated between hospital survivors and nonsurvivors (area under the curve 0.74). In multivariate analyses, for every 1% increment in red cell distribution width at the time of admission, the odds for in-hospital mortality increased by 24% (odds ratio 1.24; 95% CI, 1.20-1.27); findings were robust across comorbidity subgroups. The rate of unplanned intensive care unit transfer was 7.0% (95% CI, 6.8-7.2) and in unadjusted analyses increased more than 2-fold from 4.5% in the lowest to 11.6% in the highest red cell distribution width decile. This relationship was significantly confounded but remained significant in multivariate analysis (odds ratio 1.04 per 1% red cell distribution width increment; 95% CI, 1.03-1.06).
Red cell distribution width strongly and independently predicted in-hospital mortality in this large cohort of hospitalized patients. It also was associated with acute decompensation among patients on the general ward, but to a lesser degree. The mechanisms underlying these findings are unknown.
既往研究表明，红细胞分布宽度（红细胞大小变异性的衡量指标）可预测长期死亡率，尤其是在心血管疾病中。但对于急性住院患者，红细胞分布宽度在预后中的作用研究较少。
我们对 74784 例连续入院的成年患者进行了前瞻性数据分析，入院时测量了红细胞分布宽度。主要观察终点为院内死亡率，次要观察终点为无计划转入重症监护病房。我们使用多变量逻辑回归模型，对年龄、性别、种族和合并症进行了调整。
总的院内死亡率为 1.3%（95%置信区间[CI]，1.2-1.4）。随着红细胞分布宽度的增加，死亡率也随之升高，从最低红细胞分布宽度十分位数的 0.2%上升到最高红细胞分布宽度十分位数的 4.4%。未校正的红细胞分布宽度能显著区分住院存活者和死亡者（曲线下面积 0.74）。多变量分析显示，入院时红细胞分布宽度每增加 1%，院内死亡率的比值比增加 24%（比值比 1.24；95%CI，1.20-1.27）；该结果在合并症亚组中是稳健的。无计划转入重症监护病房的比例为 7.0%（95%CI，6.8-7.2），在未校正分析中，从最低红细胞分布宽度十分位数的 4.5%增加到最高红细胞分布宽度十分位数的 11.6%，增加了两倍多。这种关系虽然受到显著混杂因素的影响，但在多变量分析中仍然显著（每增加 1%红细胞分布宽度，比值比为 1.04；95%CI，1.03-1.06）。
在这个大型住院患者队列中，红细胞分布宽度强烈且独立地预测了院内死亡率。它还与普通病房患者的急性失代偿有关，但程度较轻。这些发现的机制尚不清楚。
