Department of Nursing, The First People's Hospital of Changde City, Changde, People's Republic of China.
Department of Science and Education, The First People's Hospital of Changde City, Changde, People's Republic of China.
Medicine (Baltimore). 2024 May 24;103(21):e38306. doi: 10.1097/MD.0000000000038306.
We investigated the relationship among red cell distribution width (RDW), to total serum calcium (TSC) ratio (RCR), and in-hospital mortality in patients with acute ischemic stroke (AIS). This study was a retrospective analysis. The data of 2700 AIS patients was retrospectively analyzed from the Medical Information Mart for Intensive Care database (version IV). The main outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether RCR was independently associated with in-hospital mortality. The Kaplan-Meier method was used to plot the survival curves for RCR. Subgroup analyses were performed to measure the mortality across various subgroups. The area under curve (AUC) of receiver operating characteristic curve (ROC) was calculated to ascertain the quality of RCR as a predictor of in-hospital mortality in patients with AIS. In the multivariate analysis, statistically significant differences were identified in age, ethnicity, length of ICU stay, mechanical ventilation, sequential organ failure assessment (SOFA) score, RDW, hemoglobin, RCR, whether taking anticoagulants, hyperlipidemia, and atrial fibrillation (P < .05). A threshold inflection point value of 1.83 was obtained through a two-piecewise regression model. There was a non-linear relationship between RCR and hospital mortality in patients with AIS. The hazard ratio (HR) and the 95% confidence intervals (CI) on the right and left of the inflection point were 0.93 (0.57-1.51; P = .7660) and 2.96 (1.37-6.42; P = .0060), respectively. The Kaplan-Meier curve indicated that survival rates were higher when RCR was ≤ 1.83 and lower when RDW was > 1.83 after adjustment for age, gender, BMI, ethnicity. The area under curve (AUC) of RCR was 0.715. A higher RCR was associated with an increased risk of in-hospital mortality in patients with AIS.
我们研究了红细胞分布宽度（RDW）与总血清钙（TSC）比值（RCR）与急性缺血性脑卒中（AIS）患者住院死亡率之间的关系。本研究为回顾性分析。从医疗信息监护 IV 版数据库中回顾性分析了 2700 例 AIS 患者的数据。主要观察终点为住院死亡率。采用 Cox 比例风险回归模型来确定 RCR 是否与住院死亡率独立相关。采用 Kaplan-Meier 法绘制 RCR 的生存曲线。进行亚组分析以衡量不同亚组的死亡率。计算接收者操作特性曲线（ROC）的曲线下面积（AUC），以确定 RCR 作为预测 AIS 患者住院死亡率的指标的质量。在多变量分析中，年龄、种族、ICU 住院时间、机械通气、序贯器官衰竭评估（SOFA）评分、RDW、血红蛋白、RCR、是否使用抗凝剂、高脂血症和心房颤动等方面存在统计学显著差异（P<0.05）。通过两段式回归模型获得 1.83 的截断点值。AIS 患者的 RCR 与住院死亡率之间存在非线性关系。拐点右侧和左侧的危险比（HR）和 95%置信区间（CI）分别为 0.93（0.57-1.51；P=0.7660）和 2.96（1.37-6.42；P=0.0060）。Kaplan-Meier 曲线表明，在调整年龄、性别、BMI、种族后，当 RCR≤1.83 时，生存率较高，而当 RDW>1.83 时，生存率较低。RCR 的曲线下面积（AUC）为 0.715。较高的 RCR 与 AIS 患者住院死亡率的增加相关。
