Red cell distribution width and all-cause mortality in critically ill patients.
Red cell distribution width and all-cause mortality in critically ill patients.
复制标题
重症患者的红细胞分布宽度和全因死亡率。
DOI：
10.1097/ccm.0b013e31821b85c6
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发表时间：
2011-08
影响因子：
8.8
通讯作者：
Christopher KB
中科院分区：
文献类型：
--
作者：
Bazick HS;Chang D;Mahadevappa K;Gibbons FK;Christopher KB
红细胞分布宽度（RDW）是一般人群死亡率的预测指标。目前还不清楚RDW在重症监护病房的发病率及其意义。在1997年至2007年间接受危重护理的马萨诸塞州波士顿两所三级医院51,413例年龄≥18岁的患者暴露于RDW，并按五分位数先验分类为≤13.3%、13.3-14.0%、14.0-14.7%、14.7-15.8%和bb0 - 15.8%。Logistic回归分析了重症监护开始后第30、90和365天的死亡率、住院死亡率和血液感染。校正后的优势比采用多变量logistic回归模型估计。调整包括年龄、性别、种族、Deyo-Charlson指数、CABG、MI、CHF、红细胞压积、白细胞、MCV、BUN、红细胞输血、败血症和肌酐。无RDW是重症监护开始后30天全因死亡率的一个特别强的预测因子，多变量调整后RDW五分位数的风险梯度显著：RDW 13.3-14.0% OR 1.19 (95% CI, 1.08-1.30； P<0.001)；RDW 14.0 -14.7%或1.28 (95% CI, 1.16 - -1.42; P < 0.001);RDW 14.7 -15.8%或1.69 (95% CI, 1.52 - -1.86; P < 0.001);RDW > 15.8%或2.61 (95% CI, 2.37 - -2.86; P < 0.001);均相对于RDW≤13.3%的患者。多变量调整后，在重症监护开始后第90天和365天的死亡率以及住院死亡率中也发现了类似的显著相关性。在对抽血培养患者（n= 18,525）的亚分析中，重症监护开始时的RDW与血液感染的风险相关，并且在多变量调整后仍然显著。与RDW≤13.3%的患者相比，RDW值在14.7-15.8%和bb0 - 15.8%的患者血液感染的调整风险分别高出1.40倍和1.44倍。估计ROC AUC显示RDW对30天死亡率具有中等判别能力（AUC = 0.67）。RDW是危重患者全因死亡率和血流感染风险的可靠预测指标。RDW是一种常用的测量方法，价格低廉且可广泛获得，可反映危重患者的整体炎症、氧化应激或动脉欠充。
Red Cell Distribution Width (RDW) is a predictor of mortality in the general population. The prevalence of increased RDW and its significance in the intensive care unit are unknown. To investigate the association between RDW at the initiation of critical care and all cause mortality Multicenter observational study Two tertiary academic hospitals in Boston, Massachusetts 51,413 patients, age ≥ 18 years, who received critical care between 1997 and 2007 The exposure of interest was RDW and categorized a priori in quintiles as ≤13.3%, 13.3–14.0%, 14.0–14.7%, 14.7–15.8%, and >15.8%. Logistic regression examined death by days 30, 90 and 365 post-critical care initiation, in-hospital mortality and bloodstream infection. Adjusted odds ratios were estimated by multivariable logistic regression models. Adjustment included age, sex, race, Deyo-Charlson index, CABG, MI, CHF, hematocrit, WBC, MCV, BUN, red blood cell transfusion, sepsis and creatinine. None RDW was a particularly strong predictor of all cause mortality 30 days following critical care initiation with a significant risk gradient across RDW quintiles following multivariable adjustment: RDW 13.3–14.0% OR 1.19 (95% CI, 1.08–1.30; P<0.001); RDW 14.0–14.7% OR 1.28 (95% CI, 1.16–1.42; P<0.001); RDW 14.7–15.8% OR 1.69 (95% CI, 1.52–1.86; P<0.001); RDW > 15.8% OR 2.61 (95% CI, 2.37–2.86; P<0.001); all relative to patients with RDW ≤13.3%. Similar significant robust associations post multivariable adjustments are seen with death by days 90 and 365 post-critical care initiation as well as in-hospital mortality. In a sub-analysis of patients with blood cultures drawn (n= 18,525), RDW at critical care initiation was associated with the risk of bloodstream infection and remained significant following multivariable adjustment. The adjusted risk of bloodstream infection was 1.40- and 1.44-fold higher in patients with RDW values in the 14.7–15.8% and >15.8% quintiles, respectively, compared with those with RDW ≤13.3%. Estimating the ROC AUC shows that RDW has moderate discriminative power for 30-day mortality (AUC = 0.67). RDW is a robust predictor of the risk of all cause patient mortality and bloodstream infection in the critically ill. RDW is commonly measured, inexpensive and widely available and may reflect overall inflammation, oxidative stress, or arterial underfilling in the critically ill.