摘要
目的分析红细胞分布宽度(red blood cell distribution width,RDW)动态变异性与慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者再入院风险的相关性。方法选择2021年1月至2023年12月我院收治的96例AECOPD患者,根据入院第1 d、第4 d的RDW动态变化分为正常组30例、降低组32例和升高组34例。采集患者基础疾病、白细胞(white blood cell,WBC)等参数;采用Logistic回归分析AECOPD患者出院后30 d再入院风险因素,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)预测。结果与正常组、降低组相比,升高组出院后30 d再入院12例(35.29%)、白细胞(white blood cell,WBC)水平(8.26±1.95)×10^(9)/L、C反应蛋白(C reactive protein,CRP)水平高(30.76±6.31)mg/L,血红蛋白(hemoglobin,Hb)水平(116.18±21.47)g/L低(P<0.05)。单因素Logistic回归分析显示,酸碱度(pondus hydrogenii,pH)<7.35(OR=4.364,95%CI:1.435~13.269)、WBC(OR=1.456,95%CI:1.020~2.077)、CRP(OR=1.139,95%CI:1.006~1.291)及RDW动态升高(OR=10.263,95%CI:2.081~50.619)是AECOPD患者出院后30 d再入院的影响因素(P<0.05);多因素Logistic回归分析显示,pH<7.35(OR=9.610,95%CI:1.799~51.340)、CRP(OR=1.249,95%CI:1.050~.486)及RDW动态升高(OR=27.417,95%CI:3.385~222.054)是AECOPD患者出院后30 d再入院的危险因素(P<0.05)。ROC曲线分析显示,pH<7.35、CRP水平、RDW动态变化预测再入院风险曲线下面积(area under curve,AUC)95%CI分别为0.639(0.489~0.790)、0.597(0.431~0.763)、0.733(0.609~0.857),敏感度为42.10%、31.60%、68.40%,特异度为85.70%、96.10%、74.00%。结论RDW动态升高、pH<7.35及CRP水平是AECOPD患者出院后30 d再入院的危险因素。RDW动态变化可预测再入院风险,提前识别高风险患者,制定个体化、针对性干预措施,降低AECOPD患者短期内再入院率,改善预后。
Objective To analyze the correlation between dynamic variability in red blood cell distribution width(RDW)and the risk of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 96 AECOPD patients admitted to our hospital from January 2021 to December 2023 were enrolled and divided into three groups based on dynamic RDW changes on day 1 and day 4 of admission:normal group(30 cases),decreased group(32 cases),and elevated group(34 cases).Clinical parameters,including comorbidities and white blood cell(WBC)levels,were collected.Logistic regression was used to analyze risk factors for 30 day readmission after discharge,and receiver operating characteristic curve(ROC)were employed to predict prognosis.Results Compared to the normal and decreased groups,the elevated group had 12 cases(35.29%)of 30 day readmission,higher WBC levels(8.26±1.95)×10^(9)/L,higher C-reactive protein(CRP)levels(30.76±6.31)mg/L,and lower hemoglobin(Hb)levels(116.18±21.47)g/L(P<0.05).Univariate logistic regression analysis revealed that pH<7.35(OR=4.364,95%CI:1.435~13.269),WBC(OR=1.456,95%CI:1.020~2.077),CRP(OR=1.139,95%CI:1.006~1.291),and dynamic RDW elevation(OR=10.263,95%CI:2.081~50.619)were significant predictors of 30 day readmission(P<0.05).Multivariate logistic regression analysis identified pH<7.35(OR=9.610,95%CI:1.799~51.340),CRP(OR=1.249,95%CI:1.050~1.486),and dynamic RDW elevation(OR=27.417,95%CI:3.385~222.054)as independent risk factors for 30-day readmission(P<0.05).ROC curve analysis showed that pH<7.35,CRP levels,and dynamic RDW changes had areas under the curve(AUC)of 0.639(0.489~0.790),0.597(0.431~0.763),and 0.733(0.609~0.857),with sensitivities of 42.10%,31.60%,and 68.40%,and specificities of 85.70%,96.10%,and 74.00%,respectively.Conclusion Dynamic elevation of RDW,pH<7.35,and CRP levels are risk factors for 30 day readmission in AECOPD patients.Monitoring dynamic RDW changes can help predict readmission risk,identify high-risk populations early,and guide personalized interventions to reduce short-term readmission rates and improve prognosis.
作者
程辉
钱震东
吴征斌
王静静
周伟
邹圣泉
张蕾
朱天智
Cheng Hui;Qian Zhendong;Wu Zhengbin;Wang Jingjing;Zhou Wei;Zou Shengquan;Zhang Lei;Zhu Tianzhi(Department of Respiratory and Critical Care Medicine,Tongling Municipal Hospital,Tongling 244000,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第3期385-389,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
铜陵市科技计划项目(20200203043)。
关键词
肺疾病
慢性阻塞性
慢性炎症
C反应蛋白
红细胞分布宽度
Chronic obstructive pulmonary disease
Chronic inflammation
Recurrence
C-reactive protein
Red blood cell distribution width
作者简介
通信作者:王静静,Email:277627310@qq.com。
