RDW对重症监护病房心力衰竭患者院内死亡的预测价值——基于MIMIC-Ⅲ数据库的回顾性研究

doi:10.3969/j.issn.1673-8640.2023.10.009

摘要/Abstract

摘要：

目的探讨红细胞体积分布宽度（RDW）预测重症监护病房（ICU）心力衰竭（HF）患者院内死亡的价值。方法对2001—2012年重症监护医学信息数据库（MIMIC-Ⅲ）中被诊断为HF的成人患者（≥18岁）进行回顾性研究。采用受试者工作特征（ROC）曲线、多因素Logistic回归分析和净重新分类指数（NRI）分析RDW预测HF患者院内死亡的效能。结果共纳入1 177例患者。校正潜在混杂因素后，分析结果显示，高RDW与HF患者院内死亡显著相关[比值比（OR）值为1.578，95%可信区间（CI）为1.019~2.445，P=0.041]。ROC曲线分析结果显示RDW预测ICU中HF患者院内死亡的曲线下面积（AUC）为0.633；与单独使用GWTG-HF比较，GWTG-HF与RDW联用的NRI为0.325，95%CI为0.056~0.623，P=0.021。结论 RDW可用于预测ICU中HF患者的院内死亡。RDW联合GWTG-HF可提高预测价值。

关键词: 红细胞体积分布宽度, 心力衰竭, 重症监护病房, 院内死亡

Abstract:

Objective To investigate the predictive value of red blood cell distribution width（RDW） for in-hospital mortality in intensive care unit（ICU） patients with heart failure（HF）. Methods A retrospective study was conducted on adult patients（≥18 years old） diagnosed with HF from 2001 to 2012 in the medical information mart for intensive care（MIMIC-Ⅲ） database. Receiver operating characteristic（ROC） curve，multivariate Logistic regression analysis and net reclassification index（NRI） were used to investigate the prognostic value of RDW. Results Totally，1 177 patients who met the inclusion criteria were enrolled. After adjustment for potential confounders，high RDW was correlated with in-hospital mortality [odds ratio（OR）= 1.578，95% confidence interval（CI） 1.019-2.445，P=0.041]. The area under curve（AUC） of RDW for predicting in-hospital mortality among HF patients in ICU was 0.633. Compared with GWTG-HF alone，the NRI of RDW combined with GWTG-HF was 0.325（95%CI 0.056-0.623，P=0.021）. Conclusions RDW can be used to predict the in-hospital mortality of HF patients in ICU. RDW combined with GWTG-HF may increase the predictive value of in-hospital mortality.

Key words: Red blood cell distribution width, Heart failure, Intensive care unit, In-hospital mortality

中图分类号:

R446.1

段勇, 王勇, 张育民, 曾海涛, 刘擎. RDW对重症监护病房心力衰竭患者院内死亡的预测价值——基于MIMIC-Ⅲ数据库的回顾性研究[J]. 检验医学, 2023, 38(10): 951-956.

DUAN Yong, WANG Yong, ZHANG Yumin, ZENG Haitao, LIU Qing. Predictive value of red blood cell distribution width for in-hospital mortality in ICU patients with heart failure：a retrospective study based on the MIMIC-Ⅲ database[J]. Laboratory Medicine, 2023, 38(10): 951-956.

图/表 4

参考文献 21

[1]	SAFAVI K C, DHARMARAJAN K, KIM N, et al. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States[J]. Circulation, 2013, 127(8):923-929. DOI PMID
[2]	ADAMS K F Jr, FONAROW G C, EMERMAN C L, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States:rationale,design,and preliminary observations from the first 100 000 cases in the Acute Decompensated Heart Failure National Registry(ADHERE)[J]. Am Heart J, 2005, 149(2):209-216. DOI URL
[3]	OZGUL G, SEYHAN E C, ÖZGÜL M A, et al. Red blood cell distribution width in patients with chronic obstructive pulmonary disease and healthy subjects[J]. Archivos De Bronconeumologia, 2017, 53(3):107-113. DOI URL
[4]	XANTHOPOULOS A, GIAMOUZIS G, MELIDONIS A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovascular diabetology, 2017, 16(1):81. DOI PMID
[5]	LI N, ZHOU H, TANG Q. Red blood cell distribution width:a novel predictive indicator for cardiovascular and cerebrovascular diseases[J]. Disease markers, 2017, 2017:7089493.
[6]	SALVATORI M, FORMIGA F, MORENO-GÓNZALEZ R, et al. Red blood cell distribution width as a prognostic factor of mortality in elderly patients firstly hospitalized due to heart failure[J]. Kardiol Pol, 2019, 77(6):632-638. DOI PMID
[7]	WOOWIEC, ROGOWICZ D, BANACH J, et al. Prognostic significance of red cell distribution width and other red cell parameters in patients with chronic heart failure during two years of follow-up[J]. Kardiol Pol, 2016, 74(7):657-664. DOI PMID
[8]	TRUBY L K, SRIDHARAN L, FLORES R J, et al. Red cell distribution width predicts 90 day mortality in continuous-flow left ventricular assist device patients[J]. ASAIO J, 2019, 65(3):233-240. DOI PMID
[9]	PENG Y, GUAN X, WANG J, et al. Red cell distribution width is correlated with all-cause mortality of patients in the coronary care unit[J]. J Int Med Res, 2020, 48(7):300060520941317.
[10]	SOTIROPOULOS K, YERLY P, MONNEY P, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction[J]. ESC Heart Fail, 2016, 3(3):198-204. DOI PMID
[11]	IMAI R, UEMURA Y, OKUMURA T, et al. Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction[J]. J Cardiol, 2017, 70(6):591-597. DOI PMID
[12]	PETERSON P N, RUMSFELD J S, LIANG L, et al. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program[J]. Circulation Cardiovascular Quality and Outcomes, 2010, 3(1):25-32. DOI URL
[13]	WIN S, HUSSAIN I, HEBL V B, et al. Inpatient mortality risk scores and postdischarge events in hospitalized heart failure patients:a community-based study[J]. Circulation Heart failure, 2017, 10(7):e003926. DOI URL
[14]	SUZUKI S, YOSHIHISA A, SATO Y, et al. Clinical significance of get with the guidelines-heart failure risk score in patients with chronic heart failure after hospitalization[J]. Journal of the American Heart Association, 2018, 7(17):e008316. DOI URL
[15]	LYLE M, WAN S H, MURPHREE D, et al. Predictive value of the get with the guidelines heart failure risk score in unselected cardiac intensive care unit patients[J]. J Am Heart Assoc, 2020, 9(3):e012439. DOI URL
[16]	FÖRHÉCZ Z, GOMBOS T, BORGULYA G, et al. Red cell distribution width in heart failure:prediction of clinical events and relationship with markers of ineffective erythropoiesis,inflammation,renal function,and nutritional state[J]. Am Heart J, 2009, 158(4):659-666. DOI URL
[17]	WAN J, RISTENPART W D, STONE H A. Dynamics of shear-induced ATP release from red blood cells[J]. Proc Natl Acad Sci U S A, 2008, 105(43):16432-16437. DOI URL
[18]	IVERSEN P O, WOLDBAEK P R, TØNNESSEN T, et al. Decreased hematopoiesis in bone marrow of mice with congestive heart failure[J]. Am J Physiol Regul Integr Comp Physiol, 2002, 282(1):R166-R172. DOI URL
[19]	ANAND I S, GUPTA P. Anemia and iron deficiency in heart failure:current concepts and emerging therapies[J]. Circulation, 2018, 138(1):80-98. DOI URL
[20]	BOGDAN C. Oxidative burst without phagocytes:the role of respiratory proteins[J]. Nat Immunol, 2007, 8(10):1029-1031. DOI
[21]	KERCHBERGER V E, WARE L B. The role of circulating cell-free hemoglobin in sepsis-associated acute kidney injury[J]. Semin Nephrol, 2020, 40(2):148-159. DOI PMID

变量	单因素分析			多因素分析
变量	OR值	95%CI	P值	OR值	95%CI	P值
RDW	1.373	1.173~1.608	<0.001	1.578	1.019~2.445	0.041
性别
女性	参照
男性	0.878	0.628~1.226	0.444
入住ICU类型
心内科ICU	参照
内科ICU	2.266	1.373~3.740	0.001	2.051	1.129~3.596	0.018
外科ICU	2.294	1.152~4.569	0.018	2.599	1.180~5.721	0.018
心脏外科ICU	1.541	0.622~3.819	0.350	1.143	0.420~3.113	0.793
创伤外科ICU	3.369	1.503~7.542	0.003	3.256	1.305~8.121	0.011
种族
其他	参照
非裔	2.035	1.101~3.760	0.023	2.595	1.256~5.326	0.010
血管活性药物
未使用	参照
使用	0.179	0.124~0.259	<0.001	2.714	1.717~4.290	<0.001
呼吸机
未使用	参照
使用	0.487	0.347~0.684	<0.001	1.414	0.923~2.166	0.111
SOFA评分	1.246	1.195~1.336	<0.001	1.045	0.973~1.123	0.226
GWTG-HF	1.028	1.017~1.039	<0.001	1.016	1.002~1.030	0.025
ECI评分	1.058	1.044~1.072	<0.001	1.035	1.019~1.051	<0.001
体重指数	0.976	0.951~1.000	0.054
舒张压	0.975	0.959~0.991	0.003	0.999	0.978~1.021	0.610
红细胞	0.891	0.677~1.171	0.407
血红蛋白	0.912	0.823~1.011	0.080
血糖	1.002	0.999~1.005	0.270
凝血酶原时间	1.044	1.025~1.064	<0.001	1.020	0.997~1.044	0.096
NT-proBNP	1.000	1.000~1.000	0.260	1.000	1.000~1.000	0.039
乳酸	1.699	1.452~1.988	<0.001	1.547	1.290~1.855	<0.001
LVEF	0.995	0.982~1.007	0.405
住院时间	1.064	1.042~1.086	<0.001	1.028	1.003~1.053	0.031

变量	单因素分析			多因素分析
变量	OR值	95%CI	P值	OR值	95%CI	P值
RDW	1.373	1.173~1.608	<0.001	1.578	1.019~2.445	0.041
性别
女性	参照
男性	0.878	0.628~1.226	0.444
入住ICU类型
心内科ICU	参照
内科ICU	2.266	1.373~3.740	0.001	2.051	1.129~3.596	0.018
外科ICU	2.294	1.152~4.569	0.018	2.599	1.180~5.721	0.018
心脏外科ICU	1.541	0.622~3.819	0.350	1.143	0.420~3.113	0.793
创伤外科ICU	3.369	1.503~7.542	0.003	3.256	1.305~8.121	0.011
种族
其他	参照
非裔	2.035	1.101~3.760	0.023	2.595	1.256~5.326	0.010
血管活性药物
未使用	参照
使用	0.179	0.124~0.259	<0.001	2.714	1.717~4.290	<0.001
呼吸机
未使用	参照
使用	0.487	0.347~0.684	<0.001	1.414	0.923~2.166	0.111
SOFA评分	1.246	1.195~1.336	<0.001	1.045	0.973~1.123	0.226
GWTG-HF	1.028	1.017~1.039	<0.001	1.016	1.002~1.030	0.025
ECI评分	1.058	1.044~1.072	<0.001	1.035	1.019~1.051	<0.001
体重指数	0.976	0.951~1.000	0.054
舒张压	0.975	0.959~0.991	0.003	0.999	0.978~1.021	0.610
红细胞	0.891	0.677~1.171	0.407
血红蛋白	0.912	0.823~1.011	0.080
血糖	1.002	0.999~1.005	0.270
凝血酶原时间	1.044	1.025~1.064	<0.001	1.020	0.997~1.044	0.096
NT-proBNP	1.000	1.000~1.000	0.260	1.000	1.000~1.000	0.039
乳酸	1.699	1.452~1.988	<0.001	1.547	1.290~1.855	<0.001
LVEF	0.995	0.982~1.007	0.405
住院时间	1.064	1.042~1.086	<0.001	1.028	1.003~1.053	0.031