【摘要】 目的 分析红细胞分布宽度（RDW）与ICU特发性肺动脉高压患者死亡率的相关性。方法 从美国重症医学信息库（MIMIC-Ⅲv1.4）提取特发性肺动脉高压患者的临床数据，包括性别、年龄、身高、体重、RDW、白细胞（WBC）、血小板（PLT）、血糖（Glu）、血K⁺、血Na⁺、血尿素氮（BUN）、血肌酐（SCr）、动脉血氧分压（PaO₂）及序贯器官衰竭评分（SOFA）。对基线资料进行相关性分析，并对部分临床指标作Cox回归筛选患者死亡危险因素，绘制受试者工作特征曲线（ROC）,探讨危险因素死亡预测价值。分别以15.3%、15.9%、14.9%作为RDW初始值(RDW_initial)、RDW最大值(RDW_max)、RDW最小值(RDW_min)界值，并将患者分成低水平RDW组（RDW<界值的组别）和高水平RDW组（RDW≥界值的组别）,绘制Kaplan-Meier生存曲线比较患者生存率。结果 根据纳入及排除标准共纳入266例患者，其中院内存活231例，死亡35例；与存活组相比，死亡组的RDW、Glu、BUN、SOFA评分基线值较高，而PaO₂基线值较低，差异均有统计学意义（均P<0.05）。多因素Cox回归发现，患者院内、28 d及3年的死亡率与RDW_{initial/max/min}正相关（均P<0.05）,而与PaO₂负相关（均P<0.05）。ROC曲线提示，RDW_{initial/max/min}预测患者3年内发生死亡事件有统计学意义（均P<0.05）。Kaplan-Meier生存曲线显示，与低水平RDW组相比，高水平RDW组在院内、28 d及3年的死亡率更高（均P<0.05）,3年存活率更低（P<0.05）。结论 RDW是ICU特发性肺动脉高压患者死亡的独立危险因素，高水平的RDW提示患者院内、28 d及3年的死亡率高，3年生存率低。更多还原

【Abstract】 Objective To explore the relationship between red cell distribution width（RDW） and mortality in patients with idiopathic pulmonary arterial hypertension in intensive care unit. Methods We searched information from the Medical Information Mart for Intensive Care Ⅲ（MIMIC-Ⅲ v1.4）database, including gender, age, height, weight, RDW,peripheral white blood cell count（WBC）,platelet（PLT）,serum glucose（Glu）,serum potassium, serum sodium, blood urea nitrogen（BUN）,serum creatinine（SCr）,partial arterial oxygen pressure（PaO₂） and the sequential organ failure assessment（SOFA） score.Then, correlation analysis was performed on the baseline condition; cox regression was used for some clinical indicators to screen the risk factors of death in patients; receiver operating characteristic（ROC） curves were drawn to investigate the predictive value of risk factors for death.Additionally, taking the cut-off values of 15.3%,15.9%,and 14.9% as the RDW initial value(RDW _initial),RDW maximum value(RDW _max),and RDW minimum value(RDW _min),respectively, the patients were divided into low-level RDW group（group with RDW less than the cut-off value） and high-level RDW group（group with RDW greater than or equal to the cut-off value）,the survival rates between two groups were compared by the Kaplan-Meier survival curve. Results A total of 266 patients were enrolled, including 231 survivors and 35 deceased.Compared with the survival group, the baseline values of RDW,Glu, BUN,and SOFA scores in the death group were significantly higher and PaO₂ were significantly lower（P<0.05 for each）.Multivariate Cox regression showed that hospital, 28-day and 3-year mortality were positively correlated with RDW _{initial/max/min}（P<0.05）,but negatively correlated with PaO₂（P<0.05）.The ROC curve suggested that RDW _{initial/max/min} was valuable in predicting 3-year all-cause mortality（P<0.05）.Moreover, compared with the low-level RDW group, the high-level RDW group had higher mortality of hospital, 28 days, and 3 years（P<0.05）,and lower 3-year survival（P<0.05）. Conclusion RDW was an independent risk factor of patients with idiopathic pulmonary arterial hypertension in intensive care unit, and the higher level of RDW predicted the higher mortality and lower survival.更多还原