ICU多重耐药菌肺部感染患者入院24小时内红细胞分布宽度与30天内预后的关系

Relationship between red cell distribution width within 24 hours and 30-day prognosis in ICU patients with multidrug-resistant pulmonary infection

摘要:

目的研究红细胞分布宽度(RDW)在重症监护病房(ICU)多重耐药菌(MDRO)肺部感染患者预后评估中的作用。方法选取2021年1月—2022年12月某院ICU收治的MDRO肺部感染患者,根据患者预后分为预后良好组和预后不良组。比较两组患者的基本资料、红细胞分布宽度［红细胞分布宽度变异系数(RDW-CV)、红细胞分布宽度标准差(RDW-SD)］、D-二聚体(D-dimer)、降钙素原(PCT)、超敏肌钙蛋白(TNTsh)、N末端-B型尿钠肽前体(NT-proBNP)、血沉(ESR)、C反应蛋白(CRP)、白细胞介素-6(IL-6)等血清学指标。采用单因素t检验及多因素logistic回归分析血清学指标与MDRO肺部感染患者预后的关联因素,绘制受试者工作特征(ROC)曲线评估RDW对MDRO肺部感染患者预后的预测效能。结果共纳入275例MDRO肺部感染病例;年龄22~99岁;预后良好组181例(65.8%),预后不良组94例(34.2%)。预后不良组PCT、D-dimer、RDW-CV、RDW-SD、TNTsh、NT-proBNP水平高于预后良好组,差异均有统计学意义(均P＜0.05);多因素logistic回归分析显示RDW-CV［OR=19.011,95%CI(5.247~68.882),P＜0.05］、RDW-SD［OR=13.693,95%CI(3.820~49.087),P＜0.05］增高为MDRO肺部感染患者预后不良的关联因素;ROC曲线结果显示,RDW-CV、RDW-SD曲线下面积分别为0.901、0.896,最佳截断值为14.45%、49.60%。结论本研究提示RDW值与MDRO肺部感染患者的疾病结局密切相关,有望成为其预后的评估指标之一,实现提前干预和风险评估价值。

Abstract:

Objective To study the role of red blood cell distribution width (RDW) in the prognosis evaluation of multidrug-resistant organism (MDRO) pulmonary infection (PI) in patients in intensive care unit (ICU). Methods Patients with MDRO PI in the ICU of a hospital from January 2021 to December 2022 were selected, they were divided into good prognosis group and poor prognosis group based on the prognosis. Basic information and serological indicators between two groups of patients were compared, including RDW (RDW coefficient of variation ［RDW-CV］, RDW standard deviation ［RDW-SD］), D-dimer, procalcitonin (PCT), high-sensitivity troponin (TNTsh), N-terminal pro-B-type natriuretic peptide (NT-proBNP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6). Univariate t-test and multiple logistic regression were adopted to analyze the correlation factors between serological indicators and the prognosis of MDRO PI patients, receiver operating characte-ristic (ROC) curves were used to evaluate the predictive efficacy of RDW on the prognosis of MDRO PI patients. Results A total of 275 cases of MDRO PI were included in analysis, age range from 22 to 99 years old; 181 cases (65.8%) were in good prognosis group, 94 cases (34.2%) in poor prognosis group. The levels of PCT, D-dimer, RDW-CV, RDW-SD, TNTsh, and NT-proBNP in the poor prognosis group were all higher than those in the good prognosis group, differences were all statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the increase of RDW-CV (OR=19.011, 95%CI ［5.247-68.882］, P<0.05) and RDW-SD (OR=13.693, 95%CI ［3.820-49.087］, P<0.05) were associated with poor prognosis in patients with MDRO PI. ROC curve results showed that the areas under the curve of RDW-CV and RDW-SD were 0.901 and 0.896, respectively, with optimal cutoff values of 14.45% and 49.60%, respectively. Conclusion This study suggests that RDW value is closely related to the disease outcome of MDRO PI patients, and is expected to become one of the prognostic evaluation indicators, achieve early intervention and risk assessment.