Amado Carlos A, Ghadban Cristina, Manrique Adriana, Osorio Joy Selene, Ruiz de Infante Milagros, Perea Rodrigo, Gónzalez-Ramos Laura, García-Martín Sergio, Huidobro Lucia, Zuazaga Javier, Druet Patricia, Argos Pedro, Poo Claudia, Muruzábal Ma Josefa, España Helena, Andretta Guido
Department of Pulmonology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla SN, 39005, Santander, Spain.
University of Cantabria, Santander, Spain.
Intern Emerg Med. 2024 Sep;19(6):1567-1575. doi: 10.1007/s11739-024-03632-5. Epub 2024 May 9.
Monocyte distribution width (MDW) has been associated with inflammation and poor prognosis in various acute diseases. Chronic obstructive pulmonary disease (COPD) exacerbations (ECOPD) are associated with mortality. The objective of this study was to evaluate the utility of the MDW as a predictor of ECOPD prognosis. This retrospective study included patient admissions for ECOPD. Demographic, clinical and biochemical information; intensive care unit (ICU) admissions; and mortality during admission were recorded. A total of 474 admissions were included. MDW was positively correlated with the DECAF score (r = 0.184, p < 0.001) and C-reactive protein (mg/dL) (r = 0.571, p < 0.001), and positively associated with C-RP (OR 1.115 95% CI 1.076-1.155, p < 0.001), death (OR 9.831 95% CI 2.981- 32.417, p < 0.001) and ICU admission (OR 11.204 95% CI 3.173-39.562, p < 0.001). High MDW values were independent risk factors for mortality (HR 3.647, CI 95% 1.313-10.136, p = 0.013), ICU admission (HR 2.550, CI 95% 1.131-5.753, p = 0.024), or either mortality or ICU admission (HR 3.084, CI 95% 1.624-5.858, p = 0.001). In ROC analysis, a combined MDW-DECAF score had better diagnostic power (AUC 0.777 95% IC 0.708-0.845, p < 0.001) than DECAF (p = 0.023), MDW (p = 0.026) or C-RP (p = 0.002) alone. MDW is associated with ECOPD severity and predicts mortality and ICU admission with a diagnostic accuracy similar to that of DECAF and C-RP. The MDW- DECAF score has better diagnostic accuracy than MDW or DECAF alone in identifying mortality or ICU admission.
单核细胞分布宽度（MDW）与多种急性疾病中的炎症及不良预后相关。慢性阻塞性肺疾病（COPD）急性加重（ECOPD）与死亡率相关。本研究的目的是评估MDW作为ECOPD预后预测指标的效用。这项回顾性研究纳入了因ECOPD入院的患者。记录了人口统计学、临床和生化信息；重症监护病房（ICU）收治情况；以及住院期间的死亡率。共纳入474例入院病例。MDW与DECAF评分（r = 0.184，p < 0.001）和C反应蛋白（mg/dL）（r = 0.571，p < 0.001）呈正相关，且与C-RP（比值比1.115，95%置信区间1.076 - 1.155，p < 0.001）、死亡（比值比9.831，95%置信区间2.981 - 32.417，p < 0.001）和ICU收治（比值比11.204，95%置信区间3.173 - 39.562，p < 0.001）相关。高MDW值是死亡（风险比3.647，95%置信区间1.313 - 10.136，p = 0.013）、ICU收治（风险比2.550，95%置信区间1.131 - 5.753，p = 0.024）或死亡或ICU收治（风险比3.084，95%置信区间1.624 - 5.858，p = 0.001）的独立危险因素。在ROC分析中，MDW与DECAF评分的联合评分比单独的DECAF（p = 0.023）、MDW（p = 0.026）或C-RP（p = 0.002）具有更好的诊断效能（曲线下面积0.777，95%置信区间0.708 - 0.845，p < 0.001）。MDW与ECOPD严重程度相关，并能预测死亡率和ICU收治情况，其诊断准确性与DECAF和C-RP相似。在识别死亡率或ICU收治方面，MDW与DECAF的联合评分比单独的MDW或DECAF具有更好的诊断准确性。
