原创力文档red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients红细胞分布宽度提高风险预测的简化的急性生理评分没有危重病人.pdfVIP
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red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients红细胞分布宽度提高风险预测的简化的急性生理评分没有危重病人
Hunziker et al. Critical Care 2012, 16:R89
/content/16/3/R89
RESEARCH Open Access
Red cell distribution width improves the
simplified acute physiology score for risk
prediction in unselected critically ill patients
Sabina Hunziker1,2,4*†, Leo A Celi1,3,4†, Joon Lee3† and Michael D Howell1,2,4
Abstract
Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown
to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the
potential to improve the prognostic performance of the simplified acute physiology score (SAPS) to predict short-
and long-term mortality in an independent, large, and unselected population of intensive care unit (ICU) patients.
Methods: This observational cohort study includes 17,922 ICU patients with available RDW measurements from
different types of ICUs. We modeled the association between RDW and mortality by using multivariable logistic
regression, adjusting for demographic factors, comorbidities, hematocrit, and severity of illness by using the SAPS.
Results: ICU-, in-hospital-, and 1-year mortality rates in the 17,922 included patients were 7.6% (95% CI, 7.2 to 8.0),
11.2% (95% CI, 10.8 to 11.7), and 25.4% (95% CI, 24.8 to 26.1). RDW was significantly associated with in-hospital
mortality (OR per 1% increase in RDW (95%CI)) (1.14 (1.08 to 1.19), P 0.0001), ICU mortality (1.10 (1.06 to 1.15), P
0.0001), and 1-year mortality (1.20 (95% CI, 1.14 to 1.26); P 0.001). Adding RDW to SAPS significantly improved
the AUC from 0.746 to 0.774 (P 0.001) for in-hospital mortality and 0.793 to 0.805 (P 0.001) for ICU mortality.
Significant improvements in classification of SAPS were confirmed in reclassification analyses. Subgroups
demonstrated robust results for gender, age categories
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