摘要
背景重症肺炎所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)病死率高,红细胞分布宽度/白蛋白比值与重症肺炎所致ARDS预后的相关性尚不明确。目的探讨血浆红细胞分布宽度(red blood cell distribution width,RDW)与血清白蛋白(albumin,Alb)的比值(red blood cell distribution width-to-albumin ratio,RAR)对重症肺炎所致ARDS患者预后的预测价值。方法对2016年1月—2022年1月就诊于解放军总医院第一医学中心的重症肺炎所致ARDS患者进行回顾性分析。根据28 d转归情况将患者分为生存组和死亡组,收集一般资料、实验室检查指标和治疗方式等信息。利用受试者操作曲线、单因素及多因素Logistic回归、生存曲线分析评估RAR与患者28 d死亡率的关系。结果共纳入296例患者,男性185例,女性111例,平均年龄(69.7±19.4)岁。其中死亡组149(50.3%)例,生存组147(49.7%)例。与生存组患者相比,死亡组患者年龄较高[(72.9±18.5)岁vs(66.4±19.9)岁,P=0.005],慢性肾衰竭患者比例较高(38.3%vs 25.2%,P=0.016),APACHEⅡ评分较高(18.0±5.7 vs 13.6±5.7,P<0.001),SOFA评分较高(8.1±3.2 vs 6.3±3.1,P<0.001),氧合指数较低(141.2±61.2 vs 170.0±64.2,P<0.001)。多因素回归分析显示,RAR与重症肺炎所致ARDS患者28 d死亡独立关联。RAR的截断值为4.486,当RAR>4.486时,重症肺炎所致ARDS患者28 d死亡风险较高。RAR预测重症肺炎所致急性呼吸窘迫综合征患者28 d死亡风险ROC曲线下面积为0.723,敏感度为0.799,特异度为0.558。结论RAR对重症肺炎所致ARDS患者28 d预后有较好的预测价值,可作为预测该类患者预后的生物标志物。
Background The mortality rate of acute respiratory distress syndrome caused by severe pneumonia is high,and the correlation between red blood cell distribution width/albumin ratio and prognosis of acute respiratory distress syndrome caused by severe pneumonia is not yet clear.Objective To investigate the prognostic value of the ratio of plasma red cell distribution width(RDW)to serum albumin(RAR)in patients with acute respiratory distress syndrome(ARDS)caused by severe pneumonia.Methods Clinical data about patients with ARDS caused by severe pneumonia who visited the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2022 were retrospectively analyzed.The patients were divided into survival group and death group according to the 28-day outcome,and general data,laboratory tests and treatment methods were collected.The relationship between RAR and 28-day mortality was evaluated by subject operation curve,single factor and multiple factor logistic regression and survival curve analysis.Results A total of 296 patients were selected in this study,including 185 males and 111 females,with an average age of 69.7±19.4 years.Among them,149(50.3%)cases were in the death group and 147(49.7%)cases in the survival group.Compared with patients in the survival group,patients in the death group were older(72.9±18.5 years vs 66.4±19.9 years,P=0.005),had a higher proportion of patients with chronic renal failure(38.3%vs 25.2%,P=0.016),a higher APACHE II score(18.0±5.7 vs 13.6±5.7,P<0.001),a higher SOFA score(8.1±3.2 vs 6.3±3.1,P<0.001),and lower oxygenation index(141.2±61.2 vs 170.0±64.2,P<0.001).Multivariate regression analysis showed that RAR was independently associated with risk of 28-day death in ARDS patients caused by severe pneumonia.The cut-off value of RAR was 4.486.When RAR exceeded 4.486,the risk of 28-day death of ARDS patients caused by severe pneumonia was higher.The AUC was 0.723(95%CI:0.665-0.780),with a sensitivity of 0.799,and specificity of 0.558.Conclusion The RAR value h
作者
程志鹏
陈镜伊
刘雯丽
孙亚楠
梁志欣
CHENG Zhipeng;CHEN Jingyi;LIU Wenli;SUN Ya’nan;LIANG Zhixin(Department of Respiratory and Critical Care Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
2024年第4期357-361,383,共6页
Academic Journal of Chinese PLA Medical School
关键词
红细胞分布宽度
白蛋白
红细胞分布宽度/白蛋白
急性呼吸窘迫综合征
预后
red blood cell distribution width
albumin
red blood cell distribution width/albumin
acute respiratory distress syndrome
prognosis
