Turcato Gianni, Campagnaro Tommaso, Bonora Antonio, Vignola Nicola, Salvagno Gian Luca, Cervellin Gianfranco, Ricci Giorgio, Maccagnani Antonio, Lippi Giuseppe
Emergency Department, Girolamo Fracastoro Hospital San Bonifacio.
Department of Surgery, Division of General and Hepatobiliary Surgery.
Eur J Gastroenterol Hepatol. 2018 Jan;30(1):33-38. doi: 10.1097/MEG.0000000000000993.
The aim of this study was to explore whether red blood cell distribution width (RDW) can help predict the risk of short-term mortality in patients with acute decompensation of cirrhosis.
We carried out a retrospective analysis of all patients consecutively admitted to the emergency department (ED) of the University Hospital of Verona (Italy) for acute decompensation of liver cirrhosis, between 1 June 2013 and 31 December 2016. The RDW value was measured at ED admission, along with collection of clinical features and other laboratory data, and was then correlated with severity of disease (Chronic Liver Failure Consortium Acute Decompensation score; CLIF-C AD score) and 1-month mortality.
The final study population consisted of 542 patients, 80 (14.8%) of whom died within 30 days after ED admission. The median RDW of patients who died was significantly higher than the median RDW of those who survived (17.4 vs. 15.5%; P<0.001). The percentage of patients who died significantly increased across different RDW quartiles (6.8, 9.7, 11.5 and 32.1%, P<0.001). In univariate analysis, significant correlation was observed between RDW and clinical severity of acute decompensate cirrhosis (Child-Pugh score: r=0.198, P<0.001; Model for End-Stage Liver Disease score: r=0.311, P=0.001; CLIF-C AD: 0.127, P=0.005). The combination of RDW and CLIF-C AD score exhibited better performance for predicting 1-month mortality than the CLIF-C AD score alone (area under the curve=0.769 vs. 0.720; P=0.006). In multivariate analysis, RDW was independently associated with a 1.2-2.3 higher risk of 1-month mortality.
The assessment of RDW at ED admission may improve risk stratification of patients with acute decompensation of cirrhosis.
本研究旨在探讨红细胞分布宽度（RDW）是否有助于预测肝硬化急性失代偿患者的短期死亡风险。
我们对2013年6月1日至2016年12月31日期间连续入住意大利维罗纳大学医院急诊科（ED）的所有肝硬化急性失代偿患者进行了回顾性分析。在ED入院时测量RDW值，并收集临床特征和其他实验室数据，然后将其与疾病严重程度（慢性肝功能衰竭联盟急性失代偿评分；CLIF-C AD评分）和1个月死亡率相关联。
最终研究人群包括542例患者，其中80例（14.8%）在ED入院后30天内死亡。死亡患者的RDW中位数显著高于存活患者（17.4%对15.5%；P<0.001）。不同RDW四分位数的死亡患者百分比显著增加（6.8%、9.7%、11.5%和32.1%，P<0.001）。在单因素分析中，观察到RDW与急性失代偿性肝硬化的临床严重程度之间存在显著相关性（Child-Pugh评分：r=0.198，P<0.001；终末期肝病模型评分：r=0.311，P=0.001；CLIF-C AD：0.127，P=0.005）。与单独的CLIF-C AD评分相比，RDW和CLIF-C AD评分的组合在预测1个月死亡率方面表现更好（曲线下面积=0.769对0.720；P=0.006）。在多因素分析中，RDW与1个月死亡风险高1.2 - 2.3倍独立相关。
在ED入院时评估RDW可能会改善肝硬化急性失代偿患者的风险分层。
