红细胞体积分布宽度与老年髋部骨折病人预后的关系

doi:10.3969/j.issn.1003-9198.2024.01.007

摘要/Abstract

摘要： 目的探讨红细胞体积分布宽度(RDW)与老年髋部骨折病人预后的关系。方法登陆我院建立的老年髋部骨折数据库,纳入2014年1月至2021年3月收治的926例病人为研究对象,提取这些病人的临床资料和相关实验室检查结果。绘制RDW预测老年髋部骨折病人预后的ROC曲线,根据RDW的最佳截断值将病人分为高、低RDW组,并对比2组的基本临床资料。随访病人的生存情况,绘制并比较2组的Kaplan-Meier生存曲线。采用Cox比例风险模型分析影响老年髋部骨折病人预后的危险因素,并进行贫血及非贫血的分层分析。结果 RDW预测老年髋部骨折病人预后的最佳截断值为14.40%。926例病人中,低RDW组(RDW≤14.40%)661例,高RDW组(RDW>14.40%)265例,2组年龄、性别、骨折类型、输血比例、贫血比例、Charlson合并症指数(CCI)分级、伤后至入院时间、血红蛋白、白蛋白水平差异有统计学意义(P＜0.05或P＜0.01)。所有病人中位随访43.68个月,高RDW组30 d、6个月和1年死亡率均高于低RDW组(P＜0.05或P＜0.01)。多因素Cox回归分析显示,RDW>14.40%、高龄、男性、CCI≥1、保守治疗、低白蛋白是老年髋部骨折病人1年内死亡的独立危险因素(均P＜0.05)。进一步对贫血进行分层分析发现:在非贫血病人中,RDW>14.40%与老年髋部骨折病人的1年死亡风险独立相关(HR=2.969,95%CI:1.478～5.963,P=0.002),而在贫血病人中,二者无相关性(P=0.259)。结论 RDW与非贫血老年髋部骨折病人的预后密切相关。

关键词: 红细胞体积分布宽度, 髋部骨折, 老年人, 预后, 贫血

Abstract: Objective To investigate the relationship between red blood cell volume distribution width (RDW) and prognosis of elderly patients with hip fracture. Methods The clinical data and laboratory test results of 926 elderly patients with hip fractures admitted to our hospital from January 2014 to March 2021 were collected. The receiver operating characteristic (ROC) curve of RDW predicting the prognosis of the elderly patients with hip fractures was drawn. All patients were divided into the high RDW group and the low RDW group according to the optimal cut-off value of RDW. The basic clinical data were compared between the two groups. Survival situation was obtained from telephone follow-up, and the Kaplan-Meier survival curves of the two groups were plotted and compared. Cox proportional hazards model was used to analyze the risk factors for the prognosis of the elderly patients with hip fractures, and stratified analysis was performed for anemia and non-anemia. Results The optimal cut-off value of RDW was 14.40%. A total of 661 patients presented with low RDW (RDW≤14.40%) and 265 patients with high RDW (RDW＞14.40%). There were significant differences in age, gender, fracture type, blood transfusion, anemia, Charlson comorbidity index (CCI), time from injury to admission, hemoglobin and albumin levels between the two groups (P<0.05 or P<0.01). The median follow-up time was 43.68 months. Compared with the low RDW group, the high RDW group showed higher 30-day, 6-month and 1-year mortality rate (P<0.05 or P<0.01). Multivariate Cox regression analysis showed that RDW>14.40%, advanced age, male, CCI≥1, conservative treatment and low albumin were the independent risk factors for 1-year mortality of the elderly patients with hip fracture (all P<0.05). The stratified analysis showed a strong independent association between RDW>14.40% and 1-year risk of death in the non-anemic elderly patients with hip fracture (HR=2.969, 95%CI: 1.478-5.963, P=0.002), but there was no association in the patients with anemia (P=0.259). Conclusions RDW is closely related to the prognosis of non-anemic elderly patients with hip fracture.

Key words: red blood cell distribution width, hip fracture, aged, prognosis, anemia

中图分类号:

R 683.3

张明, 陈曦, 刘跃洪, 谢德, 王志聪, 兰平文, 王光林. 红细胞体积分布宽度与老年髋部骨折病人预后的关系[J]. 实用老年医学, 2024, 38(1): 22-27.

ZHANG Ming, CHEN Xi, LIU Yuehong, XIE De, WANG Zhicong, LAN Pingwen, WANG Guanglin. Relationship between red blood cell volume distribution width and prognosis of elderly patients with hip fracture[J]. Practical Geriatrics, 2024, 38(1): 22-27.

参考文献

[1] KOSO R E, SHEETS C, RICHARDSON W J, et al. Hip fracture in the elderly patients: a sentinel event[J]. Am J Hosp Palliat Care, 2018, 35(4): 612-619.
[2] BHANDAI M, SWIONTKOWSKI M. Management of acute hip fracture[J]. N Engl J Med, 2017, 377(21): 2053-2062.
[3] 唐佩福. 髋部骨折的治疗现状及展望[J]. 中华创伤骨科杂志, 2019, 21(9): 743-744.
[4] SALVAGNO G L, SANCHIS G F, PICANZA A, et al. Red blood cell distribution width: a simple parameter with multiple clinical applications[J]. Crit Rev Clin Lab Sci, 2015, 52(2): 86-105.
[5] LI N, ZHOU H, TANG Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases[J]. Dis Markers, 2017, 2017:7089493.
[6] GARBHARRAN U, CHINTHAPALLI S, HOPPER I, et al. Red cell distribution width is an independent predictor of mortality in hip fracture[J]. Age Ageing, 2013, 42(2): 258-261.
[7] LV H, ZHANG L, LONG A, et al. Red cell distribution width as an independent predictor of long-term mortality in hip fracture patients: a prospective cohort study [J]. J Bone Miner Res, 2016, 31(1): 223-233.
[8] YIN P, LV H, LI Y, et al. Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up[J]. Osteoporos Int, 2018, 29(7): 1559-1567.
[9] WEI H H, ZHU Y, ZHANG J, et al. Pretreatment red blood cell distribution width as an efficient predictor of survival in older patients undergoing hip fracture surgery [J]. Int J Clin Pract, 2021, 75(12): e14791.
[10] 张玉, 孙炜, 孙维超, 等. 入院红细胞体积分布宽度与老年髋部骨折术后肺部感染的关系及其预测价值[J]. 天津医药, 2022, 50(6): 608-612.
[11] WANG Z C, JIANG W, CHEN X, et al. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study[J]. BMC Geriatr, 2021, 21(1): 155.
[12] LUNDE A, TELL G S, PENERSEN A B, et al. The role of comorbidity in mortality after hip fracture: a nationwide Norwegian study of 38, 126 women with hip fracture matched to a general-population comparison cohort[J]. Am J Epidemiol, 2019, 188(2): 398-407.
[13] FELKER G M, ALLEN L A, POCOCK S J, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank[J]. J Am Coll Cardiol, 2007, 50(1): 40-47.
[14] HAMMONS L, FILOPEI J, STEIGER D, et al. A narrative review of red blood cell distribution width as a marker for pulmonary embolism[J]. J Thromb Thrombolysis, 2019, 48(4): 638-647.
[15] SEMBA R D, PATEL K V, FERRUCCI L, et al. Serum antioxidants and inflammation predict red cell distribution width in older women: the Women’s Health and Aging Study I[J]. Clin Nutr, 2010, 29(5): 600-604.
[16] SUN H, WEAVER C M. Decreased iron intake parallels rising iron deficiency anemia and related mortality rates in the US population[J]. J Nutr, 2021, 151(7): 1947-1955.
[17] KIM K M, LUI L Y, CAULER J A, et al. Red cell distribution width is a risk factor for hip fracture in elderly men without anemia[J]. J Bone Miner Res, 2020, 35(5): 869-874.
[18] NUNEZ J, NUNEZ E, RIZOPOULOS D, et al. Red blood cell distribution width is longitudinally associated with mortality and anemia in heart failure patients [J]. Circ J, 2014, 78(2): 410-418.