细胞分布宽度与白蛋白比值对重症肺炎所致急性呼吸窘迫综合征预后的预测价值

程志鹏; 陈镜伊; 刘雯丽; 孙亚楠; 梁志欣

doi:10.12435/j.issn.2095-5227.2024.024

细胞分布宽度与白蛋白比值对重症肺炎所致急性呼吸窘迫综合征预后的预测价值

Prognostic value of red cell distribution width/albumin ratio in patients with severe pneumonia-induced acute respiratory distress syndrome

摘要

摘要:
背景重症肺炎所致急性呼吸窘迫综合征病死率高，红细胞分布宽度/白蛋白比值与重症肺炎所致急性呼吸窘迫综合征预后的相关性尚不明确。
目的探讨血浆红细胞分布宽度(red cell distribution width，RDW)与血清白蛋白(albumin，Alb)的比值(RDW/Alb，RAR)对重症肺炎所致急性呼吸窘迫综合征患者预后的预测价值。
方法对2016年1月至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天转归情况将患者分为生存组及死亡组，收集一般资料、实验室检查及治疗方式等指标。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天死亡率的关系。
结果本研究共纳入296例患者，男性185例，女性111例，平均年龄69.7 ± 19.4。其中死亡组149(50.3%)例，生存组147(49.7%)例。与生存组患者相比，死亡组患者年龄偏高(72.9 ± 18.5 vs 66.4 ± 19.9，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天死亡独立关联。RAR的截断值为4.486，当RAR＞4.486时，重症肺炎所致ARDS患者28天死亡风险较高。RAR预测重症肺炎所致急性呼吸窘迫综合征患者28天死亡风险ROC曲线下面积为0.723，敏感性0.799，特异度0.558。
结论 RAR值对重症肺炎所致ARDS患者28天预后有较好的预测价值，可以作为预测该类患者预后的生物标志物。

Abstract:
Background The mortality rate of acute respiratory distress syndrome caused by severe pneumonia is high, and the correlation between the red blood cell distribution width/albumin ratio and the 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 has a good predictive value for the 28-day prognosis of ARDS patients caused by severe pneumonia, which can be used as a biomarker to predict the prognosis of such patients.

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