Gong Yan, Long Xianming, Jin Jun, Yang Xinjing, Fu Jianhong, Huang Fang, Huang Jian, Guo Qiang, Wang Jun
Department of Critical Care Medicine, the First Hospital of Soochow University, Suzhou 215006, Jiangsu, China (Gong Y, Jin J, Yang XJ, Fu JH, Huang F, Huang J, Guo Q, Wang J); Department of Rheumatology, the First Hospital of Soochow University, Suzhou 215006, Jiangsu, China (Long XM). Corresponding author: Wang Jun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Jun;29(6):481-485. doi: 10.3760/cma.j.issn.2095-4352.2017.06.001.
To investigate the association of red cell distribution width (RDW) with prognosis in patients with sepsis.
Patients with sepsis admitted to intensive care unit (ICU) of the First Hospital of Soochow University from January 2011 to December 2016 were enrolled. All clinical data were collected for participants, which mainly included basic data, main underlying disease, site of infection, acute physiology and chronic health evaluation II(APACHE II) score, blood routine test, biochemical test, blood gas analysis, coagulation index, procalcitonin (PCT), hospitalization days, and 28-day and 90-day mortality. Patients were divided into two groups according to whether the RDW levels were higher than the time of admission or not. Kaplan-Meier survival curve was performed to analyze 28-day and 90-day cumulative survival rates in two groups. Multivariate Cox regression analysis was done to find the independent risk factors of death in patients with sepsis.
196 septic patients were eligible to participate into this study. 150 patients (53.57%) had higher RDW levels than those at the time of admission. Compared to negative or static change of RDW group, positive change of RDW group had higher APACHE II score (20.42±6.29 vs. 16.17±6.37), more percentage of chronic kidney insufficiency (35.24% vs. 19.78%), bloodstream infection (32.38% vs. 15.38%), continuous renal replacement therapy (CRRT: 32.38% vs. 16.48%), higher level of C-reactive protein [CRP (mg/L): 14.71±3.52 vs. 11.15±7.94], and higher serum creatinine [SCr (μmol/L): 128.0 (74.0, 263.5) vs. 90.0 (57.0, 145.5)], PCT [μg/L: 3.45 (2.39, 6.64) vs. 2.35 (0.56, 3.54)], and lactic acid [Lac (mmol/L): 3.40±1.72 vs. 2.70±1.61]; and had lower levels of hematocrit (Hct: 0.357±0.128 vs. 0.437±0.143), hemoglobin [Hb (g/L): 103.60±22.63 vs. 115.67±28.49], platelets [PLT (×10/L): 133.37±87.29 vs. 191.43±87.65], albumin [Alb (g/L): 28.15±5.72 vs. 35.51±5.91], total cholesterol [TC (mmol/L): 2.43±1.12 vs. 3.05±1.55], estimated glomerular filtration rate [eGFR (mL×min×1.73 m): 82.02±63.90 vs. 125.46±83.47], and oxygenation index [PaO/FiO (mmHg, 1 mmHg = 0.133 kPa): 229.69±60.61 vs. 264.21±74.78]; and longer time of hospitalization [days: 17.0 (12.0, 21.7) vs. 11.0 (7.0, 18.0)], higher 28-day and 90-day mortality (57.14% vs. 36.26%, 62.86% vs. 47.25%) with statistically significant differences (all P < 0.05). It was shown by Kaplan-Meier survival curve that the 28-day and 90-day cumulative survival rate in positive change of RDW group was significantly lower than that of negative or static change of RDW group (χ = 8.462, χ = 6.411, both P < 0.05). It was shown by multivariate Cox regression that high APACHE II score [odds ratio (OR) = 1.049, 95% confidence interval (95%CI) = 1.010-1.090, P = 0.013] and positive change of RDW (OR = 0.517, 95%CI = 0.280-0.953, P = 0.034) were the risk factors of death in patients with sepsis.
The change of RDW values during hospitalization was related to the poor outcomes in patients with sepsis. The increase of RDW predicts the progress of sepsis and bad prognosis. Serial surveillance of RDW values could provide useful information for long-term prognosis in sepsis.
探讨红细胞分布宽度（RDW）与脓毒症患者预后的相关性。
选取2011年1月至2016年12月在苏州大学附属第一医院重症监护病房（ICU）收治的脓毒症患者。收集所有参与者的临床资料，主要包括基本资料、主要基础疾病、感染部位、急性生理与慢性健康状况评分系统II（APACHE II）评分、血常规检查、生化检查、血气分析、凝血指标、降钙素原（PCT）、住院天数以及28天和90天死亡率。根据RDW水平是否高于入院时将患者分为两组。采用Kaplan-Meier生存曲线分析两组患者的28天和90天累积生存率。进行多因素Cox回归分析以确定脓毒症患者死亡的独立危险因素。
196例脓毒症患者符合本研究纳入标准。150例患者（53.57%）的RDW水平高于入院时。与RDW组呈阴性或静态变化相比，RDW组呈阳性变化的患者APACHE II评分更高（20.42±6.29比16.17±6.37），慢性肾功能不全比例更高（35.24%比19.78%），血流感染比例更高（32.38%比15.38%），持续肾脏替代治疗（CRRT）比例更高（32.38%比16.48%），C反应蛋白水平更高[CRP（mg/L）：14.71±3.52比11.15±7.94]，血清肌酐水平更高[SCr（μmol/L）：128.0（74.0，263.5）比90.0（57.0，145.5）]，PCT[μg/L：3.45（2.39，6.64）比2.35（0.56，3.54）]，乳酸水平更高[Lac（mmol/L）：3.40±1.72比2.70±1.61]；而血细胞比容水平更低（Hct：0.357±0.128比0.437±0.143），血红蛋白水平更低[Hb（g/L）：103.60±22.63比115.67±28.49]，血小板水平更低[PLT（×10/L）：133.37±87.29比191.43±87.65]，白蛋白水平更低[Alb（g/L）：28.15±5.72比35.51±5.91]，总胆固醇水平更低[TC（mmol/L）：2.43±1.12比3.05±1.55]，估算肾小球滤过率更低[eGFR（mL×min×1.73 m）：82.02±63.90比125.46±83.47]，氧合指数更低[PaO/FiO（mmHg，1 mmHg = 0.133 kPa）：229.69±60.61比264.21±74.78]；住院时间更长[天数：17.0（12.0，21.7）比11.0（7.0，18.0）]，28天和90天死亡率更高（57.14%比36.26%，62.86%比47.25%），差异均有统计学意义（均P < 0.05）。Kaplan-Meier生存曲线显示，RDW组呈阳性变化的患者28天和90天累积生存率显著低于RDW组呈阴性或静态变化的患者（χ = 8.462，χ = 6.411，均P < 0.05）。多因素Cox回归分析显示，高APACHE II评分[比值比（OR） = 1.049，95%置信区间（95%CI） = 1.010 - 1.090，P = 0.
