红细胞分布宽度与血小板计数比值对脓毒症患儿预后的预测价值

Value of red blood cell distribution width-to-platelet count ratio in predicting the prognosis of children with sepsis

摘要:

目的 探讨入住儿童重症监护室（PICU）第1天红细胞分布宽度（RDW）与血小板计数（PLT）比值（RPR）对脓毒症患儿预后的评估价值。方法 回顾性分析PICU中186例脓毒症患儿的临床资料。根据预后分为存活组（n=151）和死亡组（n=35）。比较两组临床资料，采用Cox比例风险回归模型分析患儿预后的影响因素，并绘制受试者工作特征（ROC）曲线，评估RPR对死亡的预测效果。根据最佳截断值，将患儿分为高RPR组和低RPR组，采用Kaplan-Meier法分析两组28 d生存率。结果 死亡组RDW、降钙素原、RPR高于存活组（P < 0.05）；死亡组PLT、白蛋白低于存活组（P < 0.05）。Cox回归模型分析显示，低白蛋白、高降钙素原、高RPR为脓毒症患儿预后的独立危险因素（P < 0.05）。ROC分析显示，RPR值对脓毒症患儿预后有预测价值（P < 0.05），曲线下面积为0.937，最佳截断值为0.062，灵敏度为94.29%，特异度为77.48%。Kaplan-Meier法生存分析曲线显示，高RPR组28 d生存率低于低RPR组（P < 0.05）。结论 入住PICU第1天RPR值与脓毒症患儿预后密切相关，对脓毒症患儿的预后具有预测价值。

Abstract:

Objective To study the value of red blood cell distribution width (RDW)-to-platelet count (PLT) ratio (RPR) on the first day of admission into the pediatric intensive care unit (PICU) in predicting the prognosis of children with sepsis. Methods A retrospective analysis was performed for the clinical data of 186 children with sepsis who were hospitalized in the PICU. According to their prognosis, they were divided into a survival group with 151 children and a death group with 35 children. Clinical data were compared between the two groups. The Cox proportional-hazards regression model analysis was used to investigate the factors influencing the prognosis. The receiver operating characteristic (ROC) curve was plotted to evaluate the value of RPR in predicting death. The children were divided into a high RPR group and a low RPR group according to the optimal cut-off value, and the Kaplan-Meier method was used to compare the 28-day survival rate between the two groups. Results Compared with the survival group, the death group had significantly higher RDW, procalcitonin (PCT) and RPR (P < 0.05) and significantly lower PLT and albumin (ALB) (P < 0.05). The Cox regression model analysis showed that low ALB, high PCT and high RPR were independent risk factors for the prognosis of children with sepsis (P < 0.05). The ROC curve analysis showed that RPR had a certain value in predicting the prognosis of children with sepsis (P < 0.05), with an area under the ROC curve of 0.937, an optimal cut-off value of 0.062, a sensitivity of 94.29%, and a specificity of 77.48%. The Kaplan-Meier survival analysis showed that the high RPR group had a significantly lower 28-day survival rate than the low RPR group (P < 0.05). Conclusions RPR on the first day of admission into the PICU is closely associated with the prognosis of children with sepsis and has an important value in predicting the prognosis of children with sepsis.