Objective To explore the value of red blood cell distribution width ( RDW) and its dynamic changes after admission in assessing the severity and prognostic evaluation of acute pancreatitis ( AP) . Methods One hundred and twenty cases of AP patients including 43 cases of mild acute pancreatitis ( MAP ) , 32 cases of moderate severe acute pancreatitis ( MSAP) and 45 cases of severe acute pancreatitis ( SAP) from Jan. 2010 to Jun. 2017 in the Affiliated Hospital of Guilin Medical University were selected. According to the diagnostis of SAP or not, patients were divided in-to non-SAP group (75 cases) and SAP group (45 cases). Patients in SAP group were divided into survival group (25 cases) and death group (20 cases), 30 healthy volunteers were selected as the control group. RDW of patients was collected at the time of admission and 48 hours after admission to hospital, as well as the RDW of the control group and other relevant clinical data were collected. The difference value of RDW in each group, the dynamic changes of the RDW and the correlation of RDW with APACHE Ⅱ score, Ranson score were compared. The value of RDW to the severity and prognosis of AP were analyzed by the ROC curve and area under curve ( AUC) . Results The RDW of SAP group at the time of admission and 48 hours after admission to hospital were significantly higher than those in the other three groups (P<0. 001). In the SAP group and MSAP group, the RDW at the time of admission was not significantly changed after 48 hours in hospital (P>0. 05). In a multiariable Logistic regression analysis, RDW, APACHEⅡscore and Ranson score indexes at the time of admission were all independent risk factors for SAP diagnosis and hospital death ( P<0 . 05 ) . The ROC curve analysis of the prediction value of SAP in admission showed that the RDW AUC was 0 . 953 (95% CI: 0. 899 -0. 983, P <0. 001). According to the Youden index, the optimal critical value of RDW when admission was 13 . 9 % and the sensitivity was 95 . 56 % and the specificity was 81 . 33 %. RDW on admission to hospital to prognosis of death in the hospital in SAP group of ROC curve analysis showed that RDW AUC was 0 . 849 ( 95%CI:0. 711-0. 938, P<0. 001). According to the Youden index, the optimal critical value of RDW when admission was 16 . 2% and the sensitivity was 70 . 00% and the specificity was 92 . 00%. Conclusion RDW can predict the sever-ity and prognosis of AP, and the dynamic change of RDW may have important value to predict the condition of it.%目的 探讨红细胞分布宽度(red blood cell distribution width,RDW)水平及入院后其动态变化对急性胰腺炎(acutepancreatitis,AP)病情预后的评估价值.方法 选择2010年1月至2017年6月在桂林医学院附属医院收治的AP患者120例,设轻症组(MAP,43例)、中-重症组(MSAP,32例)及重症组(SAP,45例);根据是否诊断为SAP组,分为非SAP组(75例)和SAP组(45例);再将SAP组分为生存组(25例)、死亡组(20例);对照组为健康体检者(30名).收集患者入院时RDW、入院48 h后RDW、对照组RDW及其他相关临床资料,比较各组间RDW的差异、RDW的动态变化、RDW与APACHEⅡ评分、Ranson评分的相关性,利用受试者工作特征曲线(ROC)并确定曲线下面积(AUC)来分析RDW对AP的严重程度和预后的价值.结果 SAP组入院时RDW及入院48 h后RDW均明显高于其他三组(P<0.001);SAP组及MSAP组中,入院48 h后RDW与入院时RDW变化不大(P>0.05);在多因素Logistic回归分析中,入院时RDW、APACHEⅡ评分、Ranson评分等指标均为SAP诊断及院内死亡的独立危险因素(P<0.05);入院时RDW对诊断SAP的预测价值ROC曲线分析显示,RDW AUC为0.953(95%CI:0.899~0.983,P<0.001);根据约登指数计算出入院时RDW最佳临界值为13.9%,敏感度为95.56%,特异度为81.33%;入院时RDW对SAP院内死亡的预测价值ROC曲线分析显示,RDW AUC为0.849(95%CI:0.711~0.938,P<0.001);根据约登指数计算出入院时RDW最佳临界值为16.2%,敏感度为70.00%,特异度为92.00%.结论 RDW可预测AP的严重程度和预后,同时RDW的动态变化对AP的病情可能具有较好的预测价值.
展开▼
