Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
World J Gastroenterol. 2019 Aug 28;25(32):4739-4748. doi: 10.3748/wjg.v25.i32.4739.
Severe acute pancreatitis (SAP) is a common condition in the intensive care unit (ICU) and has a high mortality. Early evaluation of the severity and prognosis is very important for SAP therapy. Recently, red blood cell distribution (RDW) was associated with mortality of sepsis patients and could be used as a predictor of prognosis. Similarly, RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.
To investigate the prognostic value of RDW for SAP patients.
We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017. According to the prognosis at 90 d, SAP patients were divided into a survival group and a non-survival group. RDW was extracted from a routine blood test. Demographic parameters and RDW were recorded and compared between the two groups. The receiver operator characteristic (ROC) curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.
In this retrospective cohort study, 42 SAP patients were enrolled, of whom 22 survived (survival group) and 20 died (non-survival group). The baseline parameters were comparable between the two groups. The coefficient of variation of RDW (RDW-CV), standard deviation of RDW (RDW-SD), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in the non-survival group than in the survival group ( < 0.05). The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score, respectively. The areas under the ROC curves (AUCs) of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score, among which, the AUC of RDW-SD was the greatest. The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients. When the RDW-SD was greater than 45.5, the sensitivity for predicting prognosis was 77.8% and the specificity was 70.8%. Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis, similar to the APACHE II and SOFA scores.
The RDW is greater in the non-surviving SAP patients than in the surviving patients. RDW is significantly correlated with the APACHE II and SOFA scores. RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.
重症急性胰腺炎（SAP）是重症监护病房（ICU）中常见的疾病，死亡率较高。早期评估严重程度和预后对 SAP 治疗非常重要。最近，红细胞分布宽度（RDW）与脓毒症患者的死亡率相关，可作为预后的预测指标。同样，RDW 可能与 SAP 患者的预后相关，并可作为 SAP 患者的预后指标。
探讨 RDW 对 SAP 患者预后的预测价值。
我们回顾性纳入 2015 年 6 月至 2017 年 6 月在中国医科大学附属第一医院 ICU 住院的 SAP 患者。根据 90d 的预后，将 SAP 患者分为存活组和非存活组。从常规血常规中提取 RDW。记录并比较两组患者的人口统计学参数和 RDW。绘制受试者工作特征（ROC）曲线，采用 Cox 回归分析探讨 RDW 对 SAP 患者预后的预测价值。
在这项回顾性队列研究中，纳入了 42 例 SAP 患者，其中 22 例存活（存活组），20 例死亡（非存活组）。两组患者的基线参数无差异。非存活组患者的 RDW 变异系数（RDW-CV）、RDW 标准差（RDW-SD）、急性生理学和慢性健康评估 II（APACHE II）评分和序贯器官衰竭评估（SOFA）评分均明显高于存活组（<0.05）。RDW-CV 和 RDW-SD 与 APACHE II 评分和 SOFA 评分均显著相关。RDW-CV 和 RDW-SD 的 ROC 曲线下面积（AUC）均大于 APACHE II 评分和 SOFA 评分，其中 RDW-SD 的 AUC 最大。结果表明，RDW 对预测 SAP 患者死亡率具有更好的预后价值。当 RDW-SD 大于 45.5 时，预测预后的敏感度为 77.8%，特异度为 70.8%。RDW-CV 和 RDW-SD 均可在多变量逻辑回归分析和单变量 Cox 比例风险回归分析中作为 SAP 患者死亡的独立危险因素，与 APACHE II 和 SOFA 评分相似。
非存活 SAP 患者的 RDW 高于存活患者。RDW 与 APACHE II 和 SOFA 评分显著相关。RDW 对 SAP 患者的预后价值优于 APACHE II 和 SOFA 评分，临床医生可方便地用于 SAP 患者的治疗。
