摘要
目的探讨红细胞体积分布宽度(RDW)变异系数与肝硬化合并脓毒症患者病死率间的相关性。方法选择美国重症监护医学信息-Ⅳ(MIMIC-Ⅳ)数据库2008至2019年入住麻省理工贝斯以色列迪康医学中心重症监护室(ICU)患者的真实临床资料,采用结构化查询语言从MIMIC-Ⅳ数据库中提取人口统计学信息、生理指标、实验室检查指标、合并症、住院病死率,以及序贯器官衰竭评估(SOFA)等。使用方差分析和Kruskal-Wallis检验分析不同RDW变异系数四分位数分类患者的临床特征,以及RDW变异系数与不同结局间的联系,并将临床和预后的相关变量纳入logistic回归模型进行调整模型分析,模型1根据年龄和性别调整,模型2根据年龄、性别、SOFA评分、胆红素、白蛋白、体重、白细胞计数、血肌酐、血钠、是否接受透析治疗、是否患充血性心力衰竭调整。使用全因死亡风险三次样条回归模型分析肝硬化合并脓毒症患者的RDW变异系数与住院死亡、ICU死亡及发生轻、中度意识障碍之间的剂量反应关系。通过趋势性检验分析RDW变异系数与用于分层的变量间的交互作用。结果共纳入1443例肝硬化合并脓毒症患者,年龄为59.0(52.0,67.0)岁,其中954例(66.1%)为男性,489例(33.9%)为女性,RDW变异系数为3.49±2.50。有382例患者在住院期间死亡,246例患者在入住ICU期间死亡,259例患者陷入轻、中度意识障碍。将RDW变异系数作为连续变量进行分析,未调整模型、模型1、模型2中,RDW变异系数对患者住院死亡、ICU死亡和轻、中度意识障碍患者的OR值及其95%置信区间(95%CI)分别为1.12(1.09~1.16)、1.14(1.10~1.17)、1.08(1.03~1.13),1.11(1.07~1.15)、1.12(1.08~1.16)、1.07(1.02~1.12),1.16(1.12~1.20)、1.16(1.12~1.20)、1.12(1.07~1.17)。以RDW变异系数第4四分位数区间(>4.74,29.08)作为对照进行分析,在未调整模型、模型1、模型2中,RDW变异系数对患者住院死亡、ICU死亡和轻、中度意识障碍的OR值(95%CI)分别为3.00(2.13~4.25)、3.32(2.34~4.74)、1.76(1.10~2.84),3.42(2.27~5.26)、3.81(2.50~5.90)、1.77(1.03~3.11),8.52(5.23~14.63)、8.35(5.10~14.38)、5.56(2.87~11.69)。RDW变异系数与住院死亡、ICU死亡和轻、中度意识障碍间呈线性相关(均P<0.05)。SOFA评分更高的患者中,随着RDW变异系数的增加,住院病死率、ICU病死率和轻、中度意识障碍的发生率增长程度较SOFA评分更低的患者明显(P=0.022、0.024、0.001)。结论RDW变异系数与肝硬化合并脓毒症患者院内死亡和意识障碍风险增加相关。
ObjectiveTo investigate the correlation between red cell volume distribution width(RDW)variation coefficient and mortality in patients with liver cirrhosis complicated with sepsis.MethodsFrom 2008 to 2019,the real clinical data of patients admitted to the intensive care unit(ICU)of Beth Israel Deaconess Medical Center,Massachusetts Institute of Technology were selected from the American Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ)database.Structured Query Language was used to extract the demographic information,physiological indicators,laboratory test indicators,complications,in-hospital mortality,and sequential organ failure assessment(SOFA)score from the MIMIC-Ⅳdatabase.Analysis of variance and Kruskal-Wallis test were used to analyze the characteristics of patients in different quartiles of RDW variation coefficient and the correlation between RDW variation coefficient and different outcomes.The clinical and prognostic variables were included in the logistic regression model and its adjustment models for analysis.Model 1 was adjusted according to age and gender,and model 2 was adjusted according to age,gender,SOFA score,bilirubin,albumin,body weight,white blood cell count,serum creatinine,serum sodium,dialysis treatment,and with congestive heart failure or not.A cubic spline regression model was used to analyze the dose-response relationship between RDW variation coefficient and in-hospital mortality,ICU mortality,mild to moderate disorders of consciousness in patients with liver cirrhosis complicated with sepsis.Trend tests were performed to analyze the interaction between the RDW variation coefficient and the variables used for stratification.ResultsA total of 1443 patients with liver cirrhosis complicated with sepsis were included,with a median age of 59.0(52.0,67.0)years old.Among them,954(66.1%)were male and 489(33.9%)were female.The RDW variation coefficient was 3.49±2.50.Totally 382 patients died during hospitalization,246 patients died in ICU,and 259 patients with mild to moderate disorders of consciousness.When RDW variation coefficient was analyzed as a continuous variable,the OR values(95%confidence interval(95%CI))of unadjusted model,model 1,and model 2 in in-hospital mortality,ICU mortality and mild to moderate disorders of consciousness were 1.12(1.09 to 1.16),1.14(1.10 to 1.17),1.08(1.03 to 1.13);1.11(1.07 to 1.15),1.12(1.08 to 1.16),1.07(1.02 to 1.12);and 1.16(1.12 to 1.20),1.16(1.12 to 1.20),1.12(1.07 to 1.17);respectively.The fourth quartile of RDW variation coefficient(>4.74,29.08)was taken as the control group,the OR values(95%CI)of the unadjusted model,model 1,and model 2 were 3.00(2.13 to 4.25),3.32(2.34 to 4.74),1.76(1.10 to 2.84);3.42(2.27 to 5.26),3.81(2.50 to 5.90),1.77(1.03 to 3.11);and 8.52(5.23 to 14.63),8.35(5.10 to 14.38),5.56(2.87 to 11.69);respectively.There was a linear correlation between RDW variation coefficient and in-hospital mortality,ICU mortality,mild and moderate disorders of consciousness(all P<0.05).Among patients with higher SOFA scores,along with the increase of RDW variation coefficient,the increase of in-hospital mortality,ICU mortality and the incidence of mild and moderate disorders of consciousness,were more significant than those of patients with lower SOFA scores(P=0.022,0.024,and 0.001).ConclusionVariation coefficient of RDW is associated with increased risk of disorders of consciousness and in-hospital mortality in patients with liver cirrhosis complicated with sepsis.
作者
方思哲
吴黎娜
赵悠宏
刘恩倩
陈永平
Fang Sizhe;Wu Lina;Zhao Youhong;Liu Enqian;Chen Yongping(Liver Disease Diagnosis and Treatment Center,the First Affiliated Hospital of Wenzhou Medical University,Zhejiang Provincial Key Laboratory of Precision Diagnosis and Treatment of Chronic Liver Diseases,Wenzhou 325035,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2024年第6期373-378,共6页
Chinese Journal of Digestion
关键词
红细胞体积分布宽度变异系数
脓毒症
肝硬化
病死率
Red cell volume distribution width variation coefficient
Sepsis
Liver cirrhosis
Mortality
