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目的探讨红细胞容积分布宽度(RDW)与肾移植术后急性呼吸窘迫综合征(ARDS)患者病死率的相关性。方法回顾性分析106例肾移植术后ARDS患者的临床资料,根据RDW的高低分为RDW正常组(≤15.0%,68例)和RDW升高组(>15.0%,38例)。比较两组患者的基本情况和不良事件发生情况,绘制Kaplan-Meier曲线比较两组的50 d病死率,采用Cox比例风险回归分析ARDS患者死亡的风险因素。结果 106例患者中,50 d内死亡总例数为46例(43.4%)。两组在序贯器官衰竭评估(SOFA)评分、血清肌酐、血红蛋白及血小板计数的差异有统计学意义(均为P<0.05)。RDW升高组患者的50 d病死率及感染性休克发生率明显高于RDW正常组,差异均有统计学意义(均为P<0.05),Kaplan-Meier生存曲线分析表明,RDW升高组与正常组患者的50 d病死率差异有统计学意义(P<0.01)。Cox比例风险回归法单因素分析发现,血红蛋白<100 g/L、血清肌酐>133μmol/L、血小板计数<100×109/L、重度ARDS、RDW>15.0%均为ARDS患者50 d内死亡的潜在危险因素(均为P<0.05)。多因素分析发现,重度ARDS[比值比(OR)=12.77,95%可信区间(CI)11.63~15.39,P<0.001]和RDW>15.0%(OR=2.01,95%CI 1.02~3.94,P<0.043)为ARDS患者50 d内死亡的独立危险因素。结论 RDW升高与肾移植术后ARDS患者疾病严重程度和50 d病死率相关,可以作为一项较有意义的预测肾移植术后ARDS患者预后的临床指标。
Objective To investigate the relationship between RDW and mortality in acute respiratory distress syndrome (ARDS) after renal transplantation. Methods The clinical data of 106 patients with ARDS after renal transplantation were retrospectively analyzed. According to the level of RDW, they were divided into normal RDW group (≤15.0%, 68 cases) and RDW elevated group (> 15.0%, 38 cases). The baseline and adverse events of the two groups were compared. Kaplan-Meier curves were used to compare the 50-day mortality rates and the risk factors of death in ARDS patients by Cox proportional hazards regression analysis. Results Of the 106 patients, the total number of deaths within 50 days was 46 (43.4%). There was significant difference between the two groups in SOFA score, serum creatinine, hemoglobin and platelet count (all P <0.05). The incidence of 50-day mortality and septic shock in patients with elevated RDW was significantly higher than that in normal RDW patients (all P <0.05). Kaplan-Meier survival curves showed that the RDW increased group was significantly correlated with The 50-day mortality rate in the normal group was statistically significant (P <0.01). Cox proportional hazards regression analysis revealed that hemoglobin <100 g / L, serum creatinine> 133 μmol / L, platelet count <100 × 109 / L, severe ARDS and RDW> 15.0% were all potential deaths within 50 days in ARDS patients Risk factors (all P <0.05). In the multivariate analysis, severe ARDS was significantly associated with ARDS (OR = 12.77, 95% CI, 11.63-15.39, P <0.001) and RDW> 15.0% (OR = 2.01, 95% CI 1.02-3.94, P <0.043) were independent risk factors for death within 50 days of ARDS. Conclusions The elevated RDW is associated with the severity of ARDS and the 50-day mortality after renal transplantation, which may serve as a more meaningful predictor of the prognosis of patients with ARDS after renal transplantation.