Department of Infection Management, Jiangsu Province, Taicang First People's Hospital, 58 South Changsheng Road, Taicang 215400, Taicang, No, P. R. China.
BMC Infect Dis. 2023 Oct 18;23(1):696. doi: 10.1186/s12879-023-08692-0.
Epidemiological studies have demonstrated an association between red blood cell distribution width (RDW) and the prognosis of pneumonia-associated diseases. However, prognostic value of RDW in patients with ventilator-associated pneumonia (VAP) has yet to be investigated. This study aimed to explore the association between RDW and in-hospital mortality in VAP patients and explore predictive value of RDW for VAP patients.
This retrospective cohort study included 1,543 VAP patients from the Medical Information Mart for Intensive Care IV database 2008-2019. The primary outcome was considered to 30-day in-hospital mortality of VAP patients in this study. Non-high RDW level group was defined as <15 %, and high RDW level group as ≥15%. The possible confounding factors were screened by least absolute shrinkage and selection operator regression. Univariate and multivariate COX regression analyses were used for the assessment on the association of RDW and 30-day in-hospital mortality in VAP patients. We also performed subgroup analyses. Furthermore, a comparative analysis of RDW and sequential organ failure assessment (SOFA) score and simplified acute physiology score II (SAPS II) were performed by receiver operating characteristic (ROC) curves.
The 30-day in-hospital mortality of VAP patients was approximately 19.05%. After adjusting all confounding factors, high RDW was associated with 30-day in-hospital mortality among VAP patients by using non-high RDW as the reference [hazard ratio (HR) =1.29, 95% confidence interval (CI): 1.01-1.63]. Additionally, the relationship was also robust in several populations, such as patients were younger than 60 years, or had not a history of congestive heart failure, or had a history of sepsis, or had not received renal replacement therapy, or had a duration of mechanical ventilation for more than 7 days. The result of ROC indicated that RDW had a better prognostic value in predicting 30-day in-hospital mortality for VAP patients than SOFA score and SAPS II score.
High RDW level is associated with an increased 30-day in-hospital mortality. The RDW is a promising biomarker in predicting 30-day in-hospital mortality for patients admitted to the ICU, regardless of VAP.
流行病学研究表明，红细胞分布宽度（RDW）与肺炎相关疾病的预后之间存在关联。然而，RDW 在呼吸机相关性肺炎（VAP）患者中的预后价值尚未得到研究。本研究旨在探讨 RDW 与 VAP 患者住院死亡率之间的关系，并探讨 RDW 对 VAP 患者的预测价值。
本回顾性队列研究纳入了 2008 年至 2019 年期间来自医疗信息集市重症监护 IV 数据库的 1543 例 VAP 患者。本研究的主要结局是考虑 VAP 患者的 30 天住院死亡率。非高 RDW 水平组定义为<15%，高 RDW 水平组定义为≥15%。通过最小绝对收缩和选择算子回归筛选可能的混杂因素。采用单因素和多因素 COX 回归分析评估 RDW 与 VAP 患者 30 天住院死亡率之间的关系。我们还进行了亚组分析。此外，通过接受者操作特征（ROC）曲线比较 RDW 与序贯器官衰竭评估（SOFA）评分和简化急性生理学评分 II（SAPS II）。
VAP 患者的 30 天住院死亡率约为 19.05%。在调整所有混杂因素后，与非高 RDW 组相比，高 RDW 与 VAP 患者的 30 天住院死亡率相关[风险比（HR）=1.29，95%置信区间（CI）：1.01-1.63]。此外，在年龄小于 60 岁、无充血性心力衰竭史、有败血症史、未接受肾脏替代治疗或机械通气时间超过 7 天的患者等多个亚组中，该关系也很稳健。ROC 的结果表明，RDW 在预测 VAP 患者 30 天住院死亡率方面比 SOFA 评分和 SAPS II 评分具有更好的预后价值。
高 RDW 水平与 30 天住院死亡率增加相关。RDW 是预测 ICU 住院患者 30 天住院死亡率的有前途的生物标志物，无论是否发生 VAP。
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