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目的研究红细胞分布宽度(RDW)对危重病患者预后的预测价值。方法选取河北省沧州市人民医院重症监护病房2013年6月—2015年1月资料完整的402例危重患者作为研究对象,记录患者入院后急性生理和慢性健康状况(APACHE)Ⅱ评分及RDW;根据APACHEⅡ评分将患者分为3组:<10分组(A组)、10~20分组(B组)、>20分组(C组),比较3组患者的RDW水平和病死率;评价RDW与APACHEⅡ评分之间的相关性;根据患者预后分为死亡组(n=306)和存活组(n=96),比较两组患者的APACHEⅡ评分RDW水平;利用受试者工作特征(ROC)曲线评价RDW在危重病患者预后判断中的作用。结果 B与A组比较,RDW升高,差异有统计学意义(P<0.05);C组患者RDW较A组患者显著升高(P<0.01)。A、B、C 3组患者病死率分别为8.7%、16.7%和34.6%,C组病死率与A、B两组比较,差异均有统计学意义(P<0.01)。随着APACHEⅡ评分的增加,RDW增加,病死率增加,APACHEⅡ评分与RDW呈正相关(r=0.69,P<0.01)。死亡组患者APACHEⅡ评分高于存活组,入院时红RDW水平高于存活组,差异有统计学意义(P<0.01);RDW水平的ROC曲线下面积值为0.801;APACHEⅡ评分的ROC曲线下面积值为0.724(P<0.01)。结论 RDW水平可能是预测危重患者转归较好的指标之一。
Objective To study the predictive value of the distribution width of red blood cells (RDW) in the prognosis of critically ill patients. Methods A total of 402 critically ill patients with complete data from June 2013 to January 2015 in Cangzhou People’s Hospital of Hebei Province were enrolled in this study. The acute physiology and chronic health status (APACHE) Ⅱ scores and RDW were recorded after admission. The patients were divided into three groups according to APACHEⅡscore: group A (group A), group B (10-20) and group C (group C20). The RDW and APACHEⅡscores (N = 306) and survivors (n = 96) according to the prognosis of the patients. The APACHEⅡscore RDW level was compared between the two groups. The ROC curve was used to evaluate the effect of RDW on the ROC curve The role of prognosis in critically ill patients. Results Compared with group A, RDW increased in group B, the difference was statistically significant (P <0.05). The RDW in group C was significantly higher than that in group A (P <0.01). The mortality rates of patients in group A, B and C were 8.7%, 16.7% and 34.6%, respectively. The mortality in group C was significantly higher than that in groups A and B (P <0.01). With the increase of APACHEⅡscore, RDW increased, mortality increased, APACHEⅡscore positively correlated with RDW (r = 0.69, P <0.01). The APACHEⅡscore of death group was higher than that of survivors, and the RDW level of admission was higher than that of survival group (P <0.01). The area under ROC curve of RDW was 0.801. The area under ROC curve of APACHEⅡscore Was 0.724 (P <0.01). Conclusions RDW level may be one of the indicators to predict the prognosis of critically ill patients.