| Objective The purpose of this paper is to observe the characteristics of red blood cell distribution width and investigate the clinical significance in patients with septic shock.Methods:I collected 200 patients with severe sepsis and septic shock treated from March 2010 to April 2013 in Tianjin Medical University General Hospital Emergency Center,who were analyzed retrospectively.It needed to record patients’ information,like gender,age,height et al,and examination on admission within 24 hours of blood routine test,liver function,renal function,electrolyte,CRP,PCT,ESR analysis et al.I measured the arterial blood lactate when admitted and after 24 h, and calculated 24 h lactate clearance, and recorded the RDW, MCV,CRP,PCT,WBC and Cr data.I calculated the APACHE II score on the basis of the worst clinical variables after they were hospitalized within 24 hours.According to the outcome,patients were divided into survival group and non-survival group.Patients were divided into septic shock group and septic shock with MODS group according to the severity of the disease. According as the RDW level,patients were divided into four groups:RDW<14.0%,14% ≤ RDW<16.0%,16.0% ≤ RDW<18.0 and RDW ≥18.0%,the data was compared in group and groups.Application of this paper is SPSS21.0 software package for data processing,the normal distribution of quantitative data( x ±s) Groups were compared using independent samples t test,count data using the median(quartile range),and using χ2test;Analysis the correlation of RDW and ESR,CRP,PCT,LAC,APACHE score by Spearman,s correlation analysis.Based on a single factor Logistic regression analysis to define the risk factors,We performed the multinomial Logistic regression analysis and found independent risk factors which had important effect on clinical.Meaningful indicators to draw receiver operating characteristics curve(ROC curves) and calculate the area under the curve.Compared various factors on the predictive value of death in patients.Results:(1)The following data of death group like age,WBC,MCV et al were higher than the survival group,but the data like HB,24 h lactate clearance were lower. The difference was statistically significant(P<0.05).However two groups inHCT,PLT,Pa O2,ESR,mechanical ventilation time and hospitalization days were not statistically significant(P>0.05).(2)septic shock with MODS groups in age,RDW,Cr,PCT,CRP,LAC,MCV and APACHE score were higher than the septic shock group,but HB,24 h lactate clearance were lower(P<0.05).The two groups of Hct,PLT,Pa O2,ESR,mechanical ventilation time and hospitalization days were not statistically significant(P>0.05).(3)Spearman’s correlation analysis showed that the relevant RDW and CRP,LAC,24 h lactate clearance,APACHE II score,PCT were positively(R values were 0.710 0.575 0.534 0.546,0.520,P<0.05).(4)If it compared with four groups RDW<14.0%,14.0%≤RDW<16.0%,16.0%≤RDW<18.0 and RDW≥18.0%,there were significant difference among the four groups in mortality rate,LAC,24 h lactate clearance,PCT,CRP,APACHE score,hospitalization days and number of organ failure(P<0.05).With the increase of the RDW,the mortality rate,LAC,PCT,CRP,APACHE score,hospitalization days and number of organ failure were increase,but the 24 h lactate clearance not increased.(5)Simple factor analysis reveals that age,CRP,RDW,LAC,PCT,24 h lactate clearance and APACHE score are the risk factors of prognosis of septic shock patients(P<0.05).Multinomial Logistic regression analysis showed APACHE II score,LAC,24 h lactate clearance and PCT were the independent risk factors for the prognosis of septic shock patients.(P<0.05),but RDW was not included.(P>0.05).(6)The AUC of PCT,APACHE score,LAC,24 h lactate clearance,RDW and LAC combined were 0.622 0.935 0.753 0.878 0.921,The sensitivity of RDW combined with LAC was 0.928,and the specificity was 0.786.Conclusion:RDW could be used as a risk factor of prognosis in patients with septic shock,RDW combined with LAC could improve the prognosis of patients with septic shock. |
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