Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Department of Information, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Cardiovasc Diabetol. 2022 Jun 3;21(1):91. doi: 10.1186/s12933-022-01534-4.
Red blood cell distribution width (RDW) has emerged as a prognostic factor for mortality in various diseases. Up to now, few studies have focused on the prognostic value of RDW in patients with diabetic foot ulcers (DFUs). This retrospective cohort study aimed to investigate the impact of RDW and RDW/albumin (ALB) ratio on all-cause mortality in patients with DFUs.
This study included 860 patients with DFUs in a tertiary academic hospital. The associations of RDW and RDW/ALB with all-cause mortality were assessed by multivariable cox regression analyses. The pairwise comparisons of receiver operating characteristic (ROC) curves were performed to compare the predictive performance of RDW and RDW/ALB ratio. Harrell's concordance index, integrated discrimination improvement, and net reclassification improvement were used to estimate the improvements in risk discrimination.
Patients with high RDW and RDW/ALB had lower overall survival rates (all P < 0.001). The multivariable Cox regression revealed that high RDW [adjusted hazard ratio (HR) 2.426, 95% confidence interval (CI): 1.557-3.778, P < 0.001] and high RDW/ALB (adjusted HR 2.360, 95% CI: 1.414-3.942, P = 0.001) were independent associated with high all-cause mortality. In subgroup analyses, the comparative analysis of ROC curves revealed that the discriminating ability of the RDW/ALB ratio was significantly superior to RDW in patients with no severe DFUs or no severe peripheral artery disease, or in young and middle-aged patients (all P < 0.05). Adding RDW and RDW/ALB ratio to base models improved discrimination and risk reclassification for all-cause mortality.
RDW and RDW/ALB ratio are robust and independent prognostic markers in patients with DFUs. The RDW/ALB ratio appears to be of more predictive value for mortality in younger and less severely ill patients with DFUs. Both RDW and RDW/ALB ratio can provide incremental predictive value for all-cause mortality over traditional risk factors. RDW and RDW/ALB ratio can be used to identify high-risk patients with DFUs.
红细胞分布宽度（RDW）已成为各种疾病死亡率的预后因素。到目前为止，很少有研究关注 RDW 在糖尿病足溃疡（DFU）患者中的预后价值。这项回顾性队列研究旨在探讨 RDW 和 RDW/白蛋白（ALB）比值对 DFU 患者全因死亡率的影响。
本研究纳入了一家三级学术医院的 860 例 DFU 患者。通过多变量 Cox 回归分析评估 RDW 和 RDW/ALB 与全因死亡率的关系。通过接受者操作特征（ROC）曲线的两两比较比较 RDW 和 RDW/ALB 比值的预测性能。Harrell 的一致性指数、综合判别改善和净重新分类改善用于估计风险判别能力的改善。
RDW 和 RDW/ALB 较高的患者总体生存率较低（均 P<0.001）。多变量 Cox 回归显示，RDW 较高[调整后的危险比（HR）2.426，95%置信区间（CI）：1.557-3.778，P<0.001]和 RDW/ALB 较高（调整后的 HR 2.360，95% CI：1.414-3.942，P=0.001）与全因死亡率较高独立相关。在亚组分析中，ROC 曲线的比较分析显示，在无严重 DFU 或无严重外周动脉疾病的患者、年轻和中年患者中，RDW/ALB 比值的判别能力明显优于 RDW（均 P<0.05）。在基础模型中加入 RDW 和 RDW/ALB 比值可提高全因死亡率的判别能力和风险再分类。
RDW 和 RDW/ALB 比值是 DFU 患者强有力的独立预后标志物。在年轻和病情较轻的 DFU 患者中，RDW/ALB 比值似乎对死亡率具有更高的预测价值。RDW 和 RDW/ALB 比值均能为全因死亡率提供比传统危险因素更高的增量预测价值。RDW 和 RDW/ALB 比值可用于识别 DFU 高危患者。
