Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei City, Taiwan.
Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Emergency Medicine, Shuang Ho Hospital, New-Taipei City, Taiwan.
Am J Emerg Med. 2018 Jun;36(6):949-953. doi: 10.1016/j.ajem.2017.10.056. Epub 2017 Nov 10.
RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.
This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015. Elderly patients (≥65years old) who were admitted to the ED-ICU with a diagnosis of severe sepsis and/or septic shock were included. The demographic data, biochemistry data, qSOFA, and APACHE II score were compared between survivors and nonsurvivors.
A total of 117 patients was included with mean age 81.5±8.3years old. The mean APACHE II score was 21.9±7.1. In the multivariate Cox proportional hazards model, RDW level was an independent variable for mortality (hazard ratio: 1.18 [1.03-1.35] for each 1% increase in RDW, p=0.019), after adjusting for CCI, any diagnosed malignancy, and eGFR. The AUC of RDW in predicting mortality was 0.63 (95% confidence interval [CI]: 0.52-0.74, p=0.025). In subgroup analysis, for qSOFA <2, nonsurvivors had higher RDW levels than survivors (17.0±3.3 vs. 15.3±1.4%, p=0.044).
In our study, RDW was an independent predictor of in-hospital mortality in elderly patients with sepsis. For qSOFA scores <2, higher RDW levels were associated with poor prognosis. RDW could be a potential parameter used alongside the clinical prediction rules.
RDW 是一种预后生物标志物，与心血管疾病、中风和代谢综合征的死亡率相关。对于老年患者，营养不良和多种合并症并存，这可能会影响 RDW 在脓毒症中的鉴别能力。本研究的主要目的是评估 RDW 在老年脓毒症患者中的预后价值。
这是一项回顾性队列研究，于 2015 年 4 月至 2015 年 11 月在急诊科重症监护病房（ED-ICU）进行。纳入年龄≥65 岁、因严重脓毒症和/或脓毒性休克而被收入 ED-ICU 的老年患者。比较存活者和非存活者的人口统计学数据、生化数据、qSOFA 和 APACHE II 评分。
共纳入 117 例患者，平均年龄 81.5±8.3 岁。平均 APACHE II 评分为 21.9±7.1。在多变量 Cox 比例风险模型中，RDW 水平是死亡率的独立变量（RDW 每增加 1%，死亡风险比：1.18[1.03-1.35]，p=0.019），调整了 CCI、任何诊断出的恶性肿瘤和 eGFR 后。RDW 预测死亡率的 AUC 为 0.63（95%置信区间 [CI]：0.52-0.74，p=0.025）。在亚组分析中，对于 qSOFA<2，非存活者的 RDW 水平高于存活者（17.0±3.3%比 15.3±1.4%，p=0.044）。
在本研究中，RDW 是老年脓毒症患者住院死亡率的独立预测因子。对于 qSOFA 评分<2，较高的 RDW 水平与预后不良相关。RDW 可能是临床预测规则的潜在参数。
