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

doi:10.3877/cma.j.issn.1674-6880.2019.06.002

Abstract

Abstract:

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.

Key words: Uric acid, Sepsis, Red cell distribution width

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]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(06): 367-371.

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Figures/Tables 5

References 22

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组别	例数	年龄（岁）	性别比（例，男/女）	BMI（kg/m²）	APACHEⅡ评分（分）	住院时长（d）
A组	50	56 ± 18	30/20	23 ± 4	14 ± 6	10 ± 5
B组	58	59 ± 20	32/26	22 ± 4	18 ± 8	9±5
C组	58	60 ± 16	42/16	23 ± 3	22 ± 8^a	9±7
D组	50	61 ± 14	38/12	23 ± 4	21 ± 9^a	8±5
F/χ²值	?	0.677	7.091	1.267	9.789	1.530
P值	?	0.567	0.069	0.287	<0.001	0.208

组别	例数	年龄（岁）	性别比（例，男/女）	BMI（kg/m²）	APACHEⅡ评分（分）	住院时长（d）
A组	50	56 ± 18	30/20	23 ± 4	14 ± 6	10 ± 5
B组	58	59 ± 20	32/26	22 ± 4	18 ± 8	9±5
C组	58	60 ± 16	42/16	23 ± 3	22 ± 8^a	9±7
D组	50	61 ± 14	38/12	23 ± 4	21 ± 9^a	8±5
F/χ²值	?	0.677	7.091	1.267	9.789	1.530
P值	?	0.567	0.069	0.287	<0.001	0.208

组别	例数	住院期间病死率[例（%）]	30 d病死率[例（%）]	尿酸（μmol/L）	RDW（%）
A组	50	4（8.00）	6（12.00）	170 ± 61	13.3 ± 0.6
B组	58	10（17.24）	16（27.59）	148 ± 66	15.9 ± 2.0^a
C组	58	16（27.59）	20（34.48）^a	411 ± 115^ab	13.2 ± 0.6^b
D组	50	20（40.00）^a	26（52.00）^a	412 ± 117^ab	16.0 ± 2.1^ac
F/χ²值	?	16.211	19.206	132.755	59.771
P值	?	0.001	<0.001	<0.001	<0.001

组别	例数	住院期间病死率[例（%）]	30 d病死率[例（%）]	尿酸（μmol/L）	RDW（%）
A组	50	4（8.00）	6（12.00）	170 ± 61	13.3 ± 0.6
B组	58	10（17.24）	16（27.59）	148 ± 66	15.9 ± 2.0^a
C组	58	16（27.59）	20（34.48）^a	411 ± 115^ab	13.2 ± 0.6^b
D组	50	20（40.00）^a	26（52.00）^a	412 ± 117^ab	16.0 ± 2.1^ac
F/χ²值	?	16.211	19.206	132.755	59.771
P值	?	0.001	<0.001	<0.001	<0.001

指标	AUC及95%CI	标准误	P值	敏感度及95%CI（%）	特异度及95%CI（%）	阳性预测值及95%CI（%）	阴性预测值及95%CI（%）
尿酸	0.745（0.690 ~ 0.801）	0.010	0.001	80.0（58.7 ~ 92.4）	60.2（48.9 ~ 70.6）	90.9（79.3 ~ 96.6）	37.7（25.1 ~ 52.1）
RDW	0.679（0.621 ~ 0.750）	0.039	0.003	68.0（46.4 ~ 84.3）	65.1（53.7 ~ 75.0）	87.1（75.6 ~ 93.9）	37.0（23.6 ~ 52.5）
尿酸 + RDW	0.767（0.710 ~ 0.831）	0.004	<0.001	76.0（54.5 ~ 89.8）	67.5（56.2 ~ 77.1）	90.3（79.5 ~ 96.0）	41.3（27.3 ~ 56.7）

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