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中华危重症医学杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06) : 367 -371. doi: 10.3877/cma.j.issn.1674-6880.2019.06.002

所属专题: 文献

论著

尿酸联合红细胞分布宽度对脓毒症患者短期结局的预测价值
高兰1, 李昊1, 刘红娟1, 闫晋琪1, 石秦东1,()   
  1. 1. 710061 西安,西安交通大学第一附属医院重症医学科
  • 收稿日期:2019-10-19 出版日期:2019-12-01
  • 通信作者: 石秦东
  • 基金资助:
    陕西省社会发展科技攻关项目(2015SF019)

Prognostic value of uric acid combined with red cell distribution width for short-term outcomes in patients with sepsis

Lan Gao1, Hao Li1, Hongjuan Liu1, Jinqi Yan1, Qindong Shi1,()   

  1. 1. Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2019-10-19 Published:2019-12-01
  • Corresponding author: Qindong Shi
  • About author:
    Corresponding author: Shi Qindong, Email:
引用本文:

高兰, 李昊, 刘红娟, 闫晋琪, 石秦东. 尿酸联合红细胞分布宽度对脓毒症患者短期结局的预测价值[J/OL]. 中华危重症医学杂志(电子版), 2019, 12(06): 367-371.

Lan Gao, Hao Li, Hongjuan Liu, Jinqi Yan, Qindong Shi. Prognostic value of uric acid combined with red cell distribution width for short-term outcomes in patients with sepsis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(06): 367-371.

目的

探讨尿酸联合红细胞分布宽度(RDW)在评估脓毒症患者短期临床预后中的诊断价值。

方法

将216例脓毒症患者根据尿酸及RDW水平分为A组(尿酸≤ 258 μmol/L且RDW ≤ 14.1%,50例)、B组(尿酸≤ 258 μmol/L且RDW>14.1%,58例)、C组(尿酸>258 μmol/L且RDW ≤ 14.1%,58例)、D组(尿酸>258 μmol/L且RDW>14.1%,50例)。对各组患者的住院期间病死率、30 d病死率、尿酸及RDW进行比较;同时,应用Kaplan-Meier生存曲线比较各组患者随访30 d生存曲线变化;应用受试者工作特征(ROC)曲线判断尿酸、RDW及二者联合指标对脓毒症患者住院期间及随访30 d死亡风险的预测价值。

结果

4组患者间住院期间病死率、30 d病死率、尿酸及RDW间比较,差异均有统计学意义(F= 16.211、19.206、132.755、59.771,P均<0.05)。进一步两两比较发现,住院期间病死率仅D组显著高于A组[40.00%(20/50)vs. 8.00%(4/50),P<0.008],且与C组及D组比较,A组的30 d病死率[34.48%(20/58)、52.00%(26/50)、12.00%(6/50),P均<0.008]及A组与B组的尿酸水平[(411 ± 115)、(412 ± 117)、(170 ± 61)、(148 ± 66)μmol/L,P均<0.05]均显著较低;同时,B组与D组的RDW均显著高于A组与C组[(15.9 ± 2.0)%、(16.0 ± 2.1)%、(13.3 ± 0.6)%、(13.2 ± 0.6)%,P均< 0.05]。而C组与D组间住院期间病死率(P>0.008)、30 d病死率(P>0.008)及尿酸水平(P>0.05)的比较,差异均无统计学意义。4组患者间的Kaplan-Meier生存曲线比较,差异有统计学意义(χ2= 14.102,P= 0.003),且C组及D组的生存曲线均显著低于A组(P均<0.008)。ROC曲线显示,尿酸联合RDW对脓毒症患者住院期间及随访30 d死亡风险的预测价值均明显优于尿酸(Z= 2.043,P= 0.041;Z= 2.012,P= 0.044)及RDW(Z= 2.245,P= 0.025;Z= 2.322,P= 0.020)。

结论

尿酸联合RDW能较好地预测脓毒症患者短期临床结局。

Objective

To investigate the prognostic significance of uric acid combined with red cell distribution width (RDW) for short-term outcomes in patients with sepsis.

Methods

According to the levels of uric acid and RDW, 216 patients with sepsis were divided into 4 groups: group A (uric acid ≤ 258 μmol/L and RDW ≤ 14.1%, 50 cases), group B (uric acid ≤ 258 μmol/L and RDW>14.1%, 58 cases), group C (uric acid>258 μmol/L and RDW ≤ 14.1%, 58 cases) and group D (uric acid>258 μmol/L and RDW>14.1%, 50 cases). The in-hospital and 30-day mortality rates, and the levels of uric acid and RDW were compared among the 4 groups. Meanwhile, the Kaplan-Meier survival analysis was used to estimate the 30-day survival in each group. The receiver operating characteristic (ROC) curve was used to describe the predictive value of uric acid, RDW and their combined indices for in-hospital and 30-day mortality rates.

Results

The in-hospital and 30-day mortality rates, and the levels of uric acid and RDW were significantly different among the 4 groups (F= 16.211, 19.206, 132.755, 59.771; all P<0.05). Furthermore, the in-hospital mortality rate in the group D was higher than that in the group A [40.00% (20/50) vs. 8.00% (4/50), P<0.008]. The 30-day mortality rate in the group A [34.48% (20/58), 52.00% (26/50), 12.00% (6/50); both P<0.008] and the uric acid level in the group A and group B [(411 ± 115), (412 ± 117), (170 ± 61), (148 ± 66) μmol/L; all P<0.05] decreased markedly as compared with the group C and group D. The RDW in the group B and group D was much higher than that in the group A and group C [(15.9 ± 2.0)%, (16.0 ± 2.1)%, (13.3 ± 0.6)%, (13.2 ± 0.6)%; all P<0.05]. However, the in-hospital and 30-day mortality rates (both P>0.008), and the uric acid level (P>0.05) all showed no significant differences between the group C and group D. The Kaplan-Meier survival analysis showed that the curves of 4 groups were statistically significantly different (χ2= 14.102, P= 0.003), and the curves of group C and group D were much lower than that of group A (both P<0.008). The ROC curve indicated that uric acid combined with RDW was much better than uric acid (Z= 2.043, P= 0.041; Z= 2.012, P= 0.044) and RDW (Z= 2.245, P= 0.025; Z= 2.322, P= 0.020) alone in the predictive value for in-hospital and 30-day mortality rates in patients with sepsis.

Conclusion

Uric acid combined with RDW can better predict short-term clinical outcomes in patients with sepsis.

表1 各组脓毒症患者间一般资料的比较(±s
表2 各组脓毒症患者间临床资料的比较(±s
图1 各组脓毒症患者随访30 d的Kaplan-Meier生存曲线
表3 尿酸、RDW及二者联合指标对脓毒症患者住院期间死亡风险的预测价值
表4 尿酸、RDW及二者联合指标对脓毒症患者随访30 d死亡风险的预测价值
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