Role Of Red Blood Cell Distribution Width In Assessing Severity And Prognosis Of Patients With Sepsis

Background and Purpose: Red blood cell distribution width (RDW) may facilitatethe detection of mortality and assessment of prognostic risk of a variety of differentdiseases. However, there are still few studies in our country currently abou the role ofRDW in evaluation the severity and prognosis in patients with sepsis, and its combinedeffects with other biological indicators. The purpose of this study was to investigate therelationship between RDW and the severity and prognosis in patients with sepsis, and toanalysis RDW alone and in combination with acute physiology and chronic healthevaluation II (APACHE Ⅱ) score, procalcitonin (PCT), C-reactive protein (CRP), arterialblood lactate, D-dime and other indicators in evaluation the severity and prognosis inpatients with sepsis.Methods: Basic clinical data of129cases of patients with sepsis was collected, androutine blood, arterial blood lactate, PCT, CRP, D-dimer and other laboratory parameterswere detected. Patients were divided into non-severe sepsis group and severe sepsis group(including septic shock) according to the severity of the, divided into non-survival groupand survival group according to the prognosis of the patients at28th d, and divided intoRDW normal group (≤16%) and elevated RDW group (>16%). The basic clinicalinformation and laboratory indicators of different groups were comparied, and therelationship between RDW and other laboratory indicators was analyzed. logisticregression analysis was used to determine the independent factors diagnosis of severesepsis, Cox proportional hazards regression analysis were perfromed to determin theindependent risk factors affecting prognosis. Logistic model fitting was used to form ajoint predictors of RDW in combination with other risk factors, receiver operatingcharacteristic curve (ROC curve) was used to compare RDW alone or in combination with other indicators in evaluation the severity and prognosis in patients with sepsis.Kaplan-Meier survival curves was depictedto compare the influence of different RDWgroups on the prognosis.Result:1. The median age, APACHE Ⅱ score, hospitalization time,28d mortalityrate and RDW increased rate of the severe sepsis groups was significantly higher thanthose of the non-severe sepsis group (P<0.05or P<0.01),respestively. Compared with thenon-severe sepsis group, the RDW, D-dimer, PCT, CRP, lactate levels of the severe sepsisgroup were significantly increased (P<0.05or P<0.01).2. Compared with the survivalgroup, the median age, APACHE Ⅱ score, length of stay,28d mortality, and RDWincreased rates of non-survival group was ignificantly higher (P<0.05or P<0.01). RDW,D-dimer, PCT, the median value of lactic acid of non-survival group were significantlyhigher than those of the survival group (P<0.05or P<0.01).3.The APACHE Ⅱ score was(22.3±9.4), hospitalization time was (15.9±6.8) d, severe sepsis ratio of86.8%, and28dmortality rate was42.6%of the RDW elevated group, which were significantly higher thanthose of the RDW normal group (P<0.05or P<0.01). Compared with the normal group,PCT, CRP, lactate levels of the RDW elevated group were significantly increased(P<0.05or P<0.01).4. Pearson correlation analysis showed that there was a significant positivecorrelation between RDW and PCT, CRP, lactate and APACHE Ⅱ score in patients withsepsis (P<0.05or P<0.01).5. Logistic regression analysis showed that, APACHE Ⅱscore, RDW, D-dimer, PCT, lactic acid were independent risk factor for severe sepsisjudgment (P<0.05or P<0.01). ROC curve analysis showed that, while RDW combinedwith APACHE Ⅱ score, D-dimer, PCT, or lactic acid, the area under the ROC curve(AUC) was elevated higher than RDW alone (P<0.05or P<0.01).6. Cox proportionalhazards regression analysis showed that age, APACHE Ⅱ score, RDW, D-dimer, PCT,lactic acid were independent risk factor for the prognosis of patients with sepsis (P<0.05orP<0.01). ROC curve analysis showed that,. When RDW combined withe APACHE Ⅱscore, PCT, lactic assess, the AUC were significantly higher than RDW alone (P<0.01).7.Kaplan-Meier survival analysis showed the median survival time of the RDW normalgroup was significantly higher than the RDW elevated group (P<0.01). Conclusions: RDW has a positive relationship with the degree of illness andprognosis in patients with sepsis, and it can be used as an indicator to determine theseverity and prognosis of sepsis. RDW combined with APACHE Ⅱ， PCT, D-dimeracidor lactic acid can enhance the ability to judge the severity of patients with sepsis. RDWcombined with APACHE Ⅱ，PCT, lactic acid may enhance the ability to assess theprognosis of patients with sepsis.