Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing, 100853, China.
Osteoporos Int. 2018 Jul;29(7):1559-1567. doi: 10.1007/s00198-018-4516-7. Epub 2018 Apr 14.
This study aims to detect whether there remains valuable prognostic information in fluctuation of red cell distribution width (RDW) in hip fracture patients. Results show that this readily available parameter may provide a more effective strategy for assessment of mortality risk, therefore providing a reference for clinical planning and decision-making.
Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown.
One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses.
In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions.
Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.
本研究旨在检测红细胞分布宽度（RDW）波动是否仍能为髋部骨折患者提供有价值的预后信息。结果表明，这一易于获取的参数可能为评估死亡率风险提供更有效的策略，为临床规划和决策提供参考。
一些血液学参数的波动已被证明具有预后价值。RDW 是全血细胞计数（CBC）中常规报告的参数，已被证明与各种疾病的不良预后相关。然而，接受手术治疗的髋部骨折患者 RDW 波动是否能预测长期死亡率尚不清楚。
这项前瞻性队列研究纳入了 2000 年 1 月 1 日至 2012 年 11 月 18 日期间接受手术治疗的 1330 例髋部骨折患者。测量入院至出院期间 RDW 的波动，并采用 Kaplan-Meier（KM）分析和多变量 Cox 回归模型评估该波动与死亡率之间的关系。采用 Logistic 回归分析检测 RDW 波动较大的危险因素。
除入院时的 RDW 外，出院时的高 RDW 水平也与死亡风险增加相关，而术后 RDW 无显著差异。入院至出院期间 RDW 的波动是 2 年死亡率的独立预测因素（HR 1.45，95%CI 1.06-2.00，p=0.022）。影响入院至出院期间 RDW 变化的因素包括患者的人口统计学特征和临床干预措施。
在住院期间 RDW 波动较大的髋部骨折患者，2 年全因死亡率风险增加。
