Yin P, Lv H, Zhang L, Long A, Zhang L, Tang P
Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
Osteoporos Int. 2016 Jun;27(6):2077-87. doi: 10.1007/s00198-015-3357-x. Epub 2016 Mar 14.
The prognostic value of red cell distribution width (RDW) and a combination of RDW and the American Society of Anesthesiologists (ASA) score for long-term hip fracture mortality remains unknown. Our data showed that both RDW and ASA were independent risk predictors. A combination of these two parameters may provide a more powerful strategy for the prediction of hip fracture mortality.
Red cell distribution width (RDW) has recently been suggested as an independent predictor of prognosis in a variety of disorders. The American Society of Anesthesiologists (ASA) system has been widely used to stratify patients for outcome evaluations. However, the prognostic value of RDW and a combination of RDW and the ASA score for long-term hip fracture mortality has yet to be studied.
This prospective cohort study included 1402 subjects from 2000 to 2011 with a follow-up study over a 2 year period. Cox proportional hazards models with a bootstrap validation were used to evaluate associations of RDW, ASA, and a combination of both with long-term mortality. The global fit and the area under the receiver operating characteristic (ROC) curve (AUC) for model discrimination were further analyzed.
Both RDW and ASA exhibited as independent risk predictors of 2-year mortality. The population with elevation of either RDW or ASA increased the risk of mortality (bootstrap validated hazard ratio (HR) 1.971 95 % confidence interval (CI) [1.336-3.005] p < 0.01) while those with an increase in both assessments (bootstrap validated HR 2.667 95 % CI [1.526-4.515] p < 0.01) were at the highest risk for mortality. The addition of the combination of ASA and RDW improved the discrimination power of risk prediction models (AUC increased from 0.700 to 0.723, p < 0.05).
Both RDW and ASA exhibited as independent risk predictors of 2-year hip fracture mortality. The combination of these two readily available parameters may provide a more powerful and effective strategy for the assessment of all-cause mortality in hip fracture patients.
红细胞分布宽度（RDW）以及RDW与美国麻醉医师协会（ASA）评分相结合对髋部骨折长期死亡率的预后价值尚不清楚。我们的数据表明，RDW和ASA都是独立的风险预测指标。这两个参数的组合可能为预测髋部骨折死亡率提供更有效的策略。
最近有人提出红细胞分布宽度（RDW）是多种疾病预后的独立预测指标。美国麻醉医师协会（ASA）系统已被广泛用于对患者进行分层以进行预后评估。然而，RDW以及RDW与ASA评分相结合对髋部骨折长期死亡率的预后价值尚未得到研究。
这项前瞻性队列研究纳入了2000年至2011年的1402名受试者，并进行了为期2年的随访研究。使用带有自抽样验证的Cox比例风险模型来评估RDW、ASA以及两者结合与长期死亡率之间的关联。进一步分析了模型判别力的整体拟合度和受试者工作特征（ROC）曲线下面积（AUC）。
RDW和ASA均表现为2年死亡率的独立风险预测指标。RDW或ASA升高的人群死亡率风险增加（自抽样验证风险比（HR）1.971，95%置信区间（CI）[1.336 - 3.005]，p < 0.01），而两项评估均升高的人群（自抽样验证HR 2.667，95% CI [1.526 - 4.515]，p < 0.01）死亡率风险最高。添加ASA和RDW的组合提高了风险预测模型的判别力（AUC从0.700增加到0.723，p < 0.05）。
RDW和ASA均表现为髋部骨折2年死亡率的独立风险预测指标。这两个易于获得的参数的组合可能为评估髋部骨折患者的全因死亡率提供更强大有效的策略。
