The Correlation Analysis Between Red Cell Distribution Width And Severe Multiple Trauma

Objective:To understand the relationship between the distribution of red blood cells and the prognosis of patients with severe multiple injuries in the intensive care unit,how to better assess the prognosis of patients with severe multiple injuries and explore possible mechanisms.Methods:From December 1,2015 to June 1,2016,Hangzhou,two trauma centers in 124 patients.The subjects were newly admitted to ICU patients with severe multiple injuries.The time of the investigation was 1,3,5 days after the patient was admitted to the ICU or until the ICU was discharged or discharged automatically.The general indicators of the patients were recorded,including name,sex,age,BMI,ICU time,admission diagnosis,injury mechanism,APACHE Ⅱ score,ISS score,admission MAP,heart rate,respiratory rate,body temperature,whether mechanical ventilation RDW-related information,records the patients into the ICU day 1,day 3,day 5 of the RDW,record whether the patient transfusion,recorded into the ICU white blood cell count,hemoglobin,CRP,PCT,recording patients alanine aminotransferase,creatinine.(Including deep venous thrombosis,continuous renal replacement therapy,infection,multiple organ dysfunction),prognosis outcome(including improvement to general wards,death/condition),prognosis of the subjects,including mechanical ventilation time,ICU hospital stay,whether complications Deteriorated and discharged automatically).Patients were divided into survival and death groups.The metrological data according to the normal distribution are expressed by the mean of standard deviation.The measured data of the normal distribution are expressed by the median and the quartile spacing,and the count data is expressed in the ratio or ratio.The single factor of the two groups was compared with the χ2 test,consistent with the normal distribution of the measurement data between the two groups of single factor comparison using t test,do not meet the normal distribution of measurement data between the two groups using a single factor Kruskal-Wallis H nonparametric Analysis and death-related factors were analyzed by multivariate logistic regression analysis.Results:1.The basic information of the study objectAmong the 124 patients enrolled in the study,93(75%)were female and 31 were female(25%);age(56115)years;median APACHE II score 20(17,26);median of ISS 21(18.8%),the sharp injury(4.8%),the injury rate(6.5%),the injury rate And others(4.0%).In the ICU patients with mechanical ventilation in 72 cases,accounting for 58.1%.The APACHE II score[20(16,26)vs 20(18,26),P>0.05],the ISS score[20]was significantly higher than that of the ICU patients[56±15 years vs 57±16 years old,P>0.05)(18,28)vs 22(18,30),P>0.05]were not statistically significant.2.The trend of RDWthe difference between the survival group and the death group 15.8(18.0,17.7)vs 13.8(13.6,14.9),P<0.001,D3RDW[17.0(15.0,17.7)vs 13.8(13.6,14.9),P<0.001],D5RDW[17.4(15.3,18.2)vs 13.5(13.0,14.3),P<0.001)]were significantly higher than those in survival group,statistically significant difference.The results of one-way variance analysis showed that the difference of RDW between different groups was statistically significant.The curve showed that the RDW of the death group increased gradually,while the RDW of the survival group decreased gradually.Further multiple linear regression analysis showed that D3RDW was associated with ICU hospitalization time,using vasoactive drugs,C-reactive protein levels and white blood cell counts,and there was no significant multicollinearity.3.Risk factors for death in patientsMultivariate logistic regression analysis showed that D3RDW increased(OR 2.14,95%CI:1.22～4.12),APACHE II score(OR 1.33,95%CI:1.01～1.62),anticoagulation and antiplatelet drug use OR 14.48,(OR 1.24,95%CI:1.07～1.44)were the independent risk factors for ICU death in patients with severe multiple trauma(OR=2.10,95%Cl:1.16～3.81).4.Evaluation of prognosis of patients with severe multiple trauma by RDW at different time pointsThe ROC curves of RDW on the 1st,3rd and 5th days after ICU were drawn,and the area under the curve was 0.772,0.846 and 0.857 respectively,all significan>0.5(P<0.001).According to the statistical results,the optimal cutoff point for the death prediction was 15.6%,16.5%and 15.3%,respectively,at the 1,3 and 5 days after the ICU.There was no significant difference in the area under the ROC curve between the two groups(P>0.05).5.How to better evaluate the prognosis of patientsThe ROC curves of RDW,ISS and APACHE II scores were 0.846,0.882 and 0.908,respectively,and all of them were significantly>0.5(P<0.001),respectively.The optimal cutoff points for D3RDW,ISS and APACHE II scores were 16.5%,23,22,respectively.There was no significant difference in the area under the ROC curve between the two groups.D3RDW + ISS score or D3RDW + APACHE II score combined forecast,the area under the curve were 0.934.Further comparison showed that there was significant difference in the area under the ROC curve of D3RDW combined with ISS scoring and APACHE II score and simple D3RDW predicted death(P<0.05),and there was no statistically significant difference.Conclusion:This study suggests that RDW can respond to the prognosis of patients with severe multiple trauma,increase the D3RDW,APACHE II,anticoagulation and antiplatelet drug use,ISS score is an independent risk of multiple trauma risk factors;1,3,5 days RDW on death The optimal critical points were 15.6%,16.5%and 15.3%,respectively.D3RDW,APACHE II,ISS score in the evaluation of the prognosis is no difference,D3RDW join APACHE II or ISS score,and can not improve the value of the latter evaluation.