The Value Of Dynamic Monitoring Of RDW And NLR On The Prognosis Of Patients With Acute Respiratory Distress Syndrome

ObjectiveTo investigate the predictive value of dynamic monitoring of red cell distribution width(RDW)and neutrophil lymphocyte rate(NLR)in the prognosis of patients with acute respiratory distress syndrome(ARDS).MethodsThis is a single-center retrospective study,based on the Berlin definition of ARDS in 2012,and the clinical data of 150 patients treated in the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2021 were selected.And they were divided into improvement and deterioration groups according to their prognostic status at the time of discharge from the RICU.The gender,age,underlying disease,length of RICU stay,and time of mechanical ventilation(MVt)of patients in both groups were recorded,and the peripheral blood white blood cells(WBC),hemoglobin(HGB),platelets(PLT),Creactive protein(CRP),plasma sedimentation rate(ESR),lactate(Lac),calcitoninogen(PCT),and partial pressure of oxygen(PaO2)levels,calculate oxygenation index,dynamically detect RDW,NEU and LYM levels on day 1(D1),day 3(D3),day 5(D5)and day 7(D7)of patients admitted to RICU,and calculate NLR values.The APACHE Ⅱ score was also performed.To compare the general information and the differences of WBC,HGB,PLT,CRP,ESR,Lac,and PCT levels between the two groups;to observe the trends of RDW and NLR on D1,D3,D5,and D7 of admission to RICU,and to analyze the correlation between RDW,NLR and APACHE Ⅱ score;to explore the independent risk factors affecting prognosis by using multiple linear regression analysis,and by plotting subjects’ working curve ROC to assess the sensitivity and specificity of each index on the prognosis of ARDS patients.Results1.A total of 150 patients with ARDS were included,including 68(45%)in the improvement group,48(70.6%)males and 20(29.4%)females,aged 18-85(57.22±15.81)years;82(55%)in the deterioration group,57(69.5%)males and 25(30.5%)females,aged 21-93(61.02±16.26)years.Ninety-four cases(63%)had underlying diseases.There was no statistically significant difference between the two groups in terms of gender,age,and underlying disease(P>0.05)2.The differences in WBC,HGB,PLT,CRP,ESR and length of stay in the RICU within 24h of admission to the RICU were not statistically meanfuling between the two groups(P>0.05).The RDW,NLR,Lac,PCT,APACHE Ⅱ score and MVt within 24h of admission to the RICU were higher in the deteriorating group than in the improving group,RDW:(14.91 ± 1.45)%in the deteriorating group and(14.28±1.30)%in the improving group;NLR:(17.86±3.75)in the deteriorating group and(12.91±2.89)in the improving group;Lac deteriorating group(4.52±1.92)mmol/L,improving group(3.61±0.98)mmol/L;PCT:deteriorating group(4.81±1.84)ng/mL,improving group(3.82±1.11)ng/mL;APACHE Ⅱ score:deteriorating group(22.07±6.40),improving group(17.84±5.44).MVt:deteriorating group(7.3±2.73)/d,improving group(4.97±1.53)/d,all differences were statistically significant(P<0.05).3.The RDW,NLR and APACHE Ⅱ scores of patients admitted to the RICU D1,D3,D5 and D7 were all higher in the deteriorating group compared to the improving group during the same period,all with statistically significant differences(P<0.05).4.Spearman’s correlation analysis showed that RDW and NLR were positively correlated with APACHEⅡ scores for D1,D3,D5,and D7 in the RICU(P<0.05),and the correlations were gradually increasing.The correlations between RDW and APACHEⅡ scores were 0.3920,0.432,0.447,and 0.512,respectively.r correlations between NLR and APACHE Ⅱ scores were 0.295,0.370,0.382,and 0.607,respectively.5.Multi-factorial logistic regression analysis showed that RDW(OR=1.438,95%CI 1.031～2.006,P=0.017),NLR(OR=1.065,95%CI1.007～1.127,P=0.029),Lac(OR=1.384,95%CI 1.040～1.843,P=0.026)and APACHE Ⅱ score(OR=1.079,95%CI 1.006～1.158,P=0.034)were independent risk factors for deterioration in patients with ARDS.6.ROC curve analysis indicates that the sensitivity and specificity of the combined prognostic assessment of RDW,NLR,and APACHE Ⅱ scores in RICU for D1,D3,D5,and D7 were 70.7%,75.8%;84.9%,76.5%;87.8%,80.9%,and 92.7%,83.8%,respectively,with AUCs of 0.717,0.844 The combined prognostic assessment values of all three indicators were greater than the predicted values of individual indicators.7.Conclusions1.Detection of RDW and NLR levels at the time of admission to the RICU is useful in assessing the severity of the condition of patients with ARDS.2.Dynamic changing of RDW and NLR is positively correlated with APACHEⅡscores.3.RDW,NLR and APACHEⅡ scores are independent risk factors for deterioration in ARDS patients.4.The combination of RDW,NLR and APACHEⅡ scores may improve the predictive value of prognosis in patients with ARDS.