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Article(id=1210676791014985879, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.05.08, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1605542400000, receivedDateStr=2020-11-17, revisedDate=1618329600000, revisedDateStr=2021-04-14, acceptedDate=null, acceptedDateStr=null, onlineDate=1766577440265, onlineDateStr=2025-12-24, pubDate=1622131200000, pubDateStr=2021-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766577440265, onlineIssueDateStr=2025-12-24, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766577440265, creator=13701087609, updateTime=1766577440265, updator=13701087609, issue=Issue{id=1210676785113600955, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='5', pageStart='425', pageEnd='530', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766577438858, creator=13701087609, updateTime=1766718730270, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269404306838321, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269404306838322, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=474, endPage=480, ext={EN=ArticleExt(id=1210676791358918822, articleId=1210676791014985879, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=The value of red cell volume distribution width in evaluating the clinical outcome of sepsis in the elderly, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the predictive value of red volume distribution width (RDW) for the clinical outcome of sepsis in the elderly. Methods Two hundred and ten elderly patients with sepsis admitted to the General Hospital of Eastern Theater Command of PLA from January 2018 to December 2019 were included. The highest Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score and sequential organ failure (SOFA) score were calculated during sepsis. According to clinical outcome, 210 patients were divided into septic shock (n=93) /non-shock (n=117) groups; severe (n=79)/mild organ dysfunction (n=131) groups and death (n=60)/survival groups (n=150). The differences in age, sex, smoking and drinking history, medical history, APACHE Ⅱ score, SOFA score, RDW were compared between the different groups. Spearman's correlation analysis was used to analyze the correlation between RDW and APACHE Ⅱscore, SOFA score, total hospital days and ICU hospital days. Unconditional logistic regression was used to analyze the risk factors for septic shock, severe organ dysfunction and death in elderly patients with sepsis. Receiver operating characteristic (ROC) curves were adopted to analyze the predictive value of RDW, SOFA score, and APACHE Ⅱ score for septic shock and severe organ dysfunction in elderly patients with sepsis. Results The RDW, APACHE Ⅱ score, SOFA score, the incidence of severe organ dysfunction and death in the septic shock group were higher than those of the non-sepsis group; RDW, APACHE Ⅱscore, SOFA score, the incidences of septic shock and mortality in the severe organ dysfunction group were higher than those in the mild organ dysfunction group; RDW, APACHE Ⅱ score, SOFA score, the incidence of septic shock and severe organ dysfunction in the death group were higher than those in the survival group, there was a significant difference between each group (P<0.05); RDW was positively correlated with APACHE Ⅱ score, SOFA score, total hospital days and ICU hospital days (P<0.001); Elevated RDW was an independent risk factor for septic shock and severe organ dysfunction (P<0.05); the risk of septic shock and severe organ dysfunction was significantly increased when RDW>20% (P<0.05); The ROC AUC of SOFA score was 0.958, sensitivity was 0.817, specificity was 0.940, ROC AUC of RDW combined with SOFA score was 0.959, sensitivity was 0.968, specificity was 0.676 in predicting septic shock; The ROC AUC of APACHE Ⅱ score was 0.973, sensitivity was 0.911, specificity was 0.931, the ROC AUC of the RDW combined with APACHE Ⅱ score was 0.978, sensitivity was 0.972, and specificity was 0.668 in predicting severe organ dysfunction. Conclusions RDW is an independent risk factor to predict septic shock and severe organ dysfunction in elderly patients with sepsis; RDW combined with SOFA score and RDW combined with APACHE Ⅱ score have better sensitivity to predict septic shock and severe organ dysfunction than any single factor.

, correspAuthors=Yu Liu, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨红细胞分布宽度(RDW)对老年脓毒症患者临床转归的预测价值。方法 纳入2018年1月—2019年12月东部战区总医院收治的210例老年脓毒症患者，计算脓毒症期间最高急性生理与慢性健康状态评分Ⅱ(APACHE Ⅱ)及序贯器官衰竭评分(SOFA)。根据住院期间临床转归情况，将210例患者分为脓毒性休克组(n=93)与非休克组(n=117)；根据治疗结局，将患者分为死亡组(n=60)与存活组(n=150)；根据SOFA评分将患者分为重度器官功能障碍组(SOFA≥10分，n=79)及轻度器官功能障碍组(SOFA<10分，n=131)。比较各组年龄、性别、吸烟史、饮酒史、既往史、APACHE Ⅱ评分、SOFA评分、RDW等指标的差异，采用Spearman相关分析RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间的相关性，采用非条件logistic回归分析老年脓毒症患者发生脓毒性休克、重度器官功能障碍及死亡的危险因素，采用受试者工作特征(ROC)曲线分析RDW、SOFA评分、APACHE Ⅱ评分对老年脓毒症患者发生脓毒性休克、重度器官功能障碍的预测价值。结果 脓毒性休克组RDW、APACHE Ⅱ评分、SOFA评分、重度器官功能障碍及死亡的发生率均高于非休克组，重度器官功能障碍组RDW、APACHE Ⅱ评分、脓毒性休克及死亡的发生率均高于轻度器官功能障碍组，死亡组RDW、APACHE Ⅱ评分、SOFA评分、脓毒性休克及重度器官功能障碍的发生率均高于存活组，差异有统计学意义(P<0.05)；RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间呈正相关(P<0.001)；RDW升高是脓毒性休克、重度器官功能障碍的独立危险因素(P<0.05)；RDW>20%的脓毒症患者发生脓毒性休克及重度器官功能障碍的风险明显升高(P<0.05)；SOFA评分预测脓毒性休克的ROC曲线下面积(AUC)为0.958，敏感度为0.817，特异度为0.940，RDW联合SOFA评分的AUC为0.959，敏感度为0.968，特异度为0.676；APACHE Ⅱ评分预测重度器官功能障碍的AUC为0.973，敏感度为0.911，特异度为0.931，RDW联合APACHE Ⅱ评分的AUC为0.978，敏感度为0.972，特异度为0.668。结论 RDW升高是预测老年脓毒症患者发生脓毒性休克及重度器官功能障碍的独立危险因素；RDW联合SOFA评分预测脓毒性休克及RDW联合APACHE Ⅱ评分预测重度器官功能障碍的敏感度均优于单个指标。

, correspAuthors=刘瑜, authorNote=null, correspAuthorsNote=
刘瑜，E-mail：
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杨晨，硕士研究生，主要从事老年内分泌疾病的临床与基础研究

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杨晨，硕士研究生，主要从事老年内分泌疾病的临床与基础研究

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杨晨，硕士研究生，主要从事老年内分泌疾病的临床与基础研究

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Assessment of clinical criteria for sepsis: for the third international consensus definitions for Sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 762-774., articleTitle=Assessment of clinical criteria for sepsis: for the third international consensus definitions for Sepsis and septic shock (Sepsis-3), refAbstract=null), Reference(id=1211282636547429211, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2011, volume=39, issue=8, pageStart=1913, pageEnd=1921, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=Bazick HS, Chang D, Mahadevappa K, journalName=Crit Care Med, refType=null, unstructuredReference=Bazick HS, Chang D, Mahadevappa K, et al. Red cell distribution width and all-cause mortality in critically ill patients[J]. Crit Care Med, 2011, 39(8): 1913-1921., articleTitle=Red cell distribution width and all-cause mortality in critically ill patients, refAbstract=null), Reference(id=1211282636618732380, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2012, volume=38, issue=2, pageStart=123, pageEnd=127, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Ku NS, Kim HW, Oh HJ, journalName=Shock, refType=null, unstructuredReference=Ku NS, Kim HW, Oh HJ, et al. Red blood cell distribution width is an independent predictor of mortality in patients with gram-negative bacteremia[J]. Shock, 2012, 38(2): 123-127., articleTitle=Red blood cell distribution width is an independent predictor of mortality in patients with gram-negative bacteremia, refAbstract=null), Reference(id=1211282636690035549, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2017, volume=43, issue=3, pageStart=304, pageEnd=377, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Rhodes A, Evans LE, Alhazzani W, journalName=Intensive Care Med, refType=null, unstructuredReference=Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Intensive Care Med, 2017, 43(3): 304-377., articleTitle=Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016, refAbstract=null), Reference(id=1211282636773921630, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2019, volume=95, issue=1123, pageStart=240, pageEnd=244, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=Wu QH, Xiao ZY, Pu YN, journalName=Postgrad Med J, refType=null, unstructuredReference=Wu QH, Xiao ZY, Pu YN, et al. TnI and IL-18 levels are associated with prognosis of Sepsis[J]. Postgrad Med J, 2019, 95(1123): 240-244., articleTitle=TnI and IL-18 levels are associated with prognosis of Sepsis, refAbstract=null), Reference(id=1211282636862002015, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2019, volume=7, issue=null, pageStart=e7083, pageEnd=null, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=Chen QG, Zhang LS, Ge SH, journalName=PeerJ, refType=null, unstructuredReference=Chen QG, Zhang LS, Ge SH, et al. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study[J]. PeerJ, 2019, 7: e7083., articleTitle=Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study, refAbstract=null), Reference(id=1211282636933305184, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2018, volume=28, issue=6, pageStart=503, pageEnd=511, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=Letendre JA, Goggs R, journalName=J Vet Emerg Crit Care (San Antonio), refType=null, unstructuredReference=Letendre JA, Goggs R. Determining prognosis in canine sepsis by bedside measurement of cell-free DNA and nucleosomes[J]. J Vet Emerg Crit Care (San Antonio), 2018, 28(6): 503-511., articleTitle=Determining prognosis in canine sepsis by bedside measurement of cell-free DNA and nucleosomes, refAbstract=null), Reference(id=1211282637008802657, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2015, volume=40, issue=null, pageStart=135, pageEnd=141, url=null, language=null, rfNumber=[8], rfOrder=7, authorNames=Liu JQ, Shi K, Chen MH, journalName=Int J Infect Dis, refType=null, unstructuredReference=Liu JQ, Shi K, Chen MH, et al. Elevated miR-155 expression induces immunosuppression via CD39(+) regulatory T-cells in sepsis patient[J]. Int J Infect Dis, 2015, 40: 135-141., articleTitle=Elevated miR-155 expression induces immunosuppression via CD39(+) regulatory T-cells in sepsis patient, refAbstract=null), Reference(id=1211282637088494434, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2012, volume=107, issue=7, pageStart=558, pageEnd=563, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=Wilhelm J, Hettwer S, Hammer D, journalName=Med Klin Intensivmed Notfmed, refType=null, unstructuredReference=Wilhelm J, Hettwer S, Hammer D, et al. Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department[J]. Med Klin Intensivmed Notfmed, 2012, 107(7): 558-563., articleTitle=Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department, refAbstract=null), Reference(id=1211282637172380515, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2001, volume=68, issue=12, pageStart=1117, pageEnd=1119, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=Viswanath D, Hegde R, Murthy V, journalName=Indian J Pediatr, refType=null, unstructuredReference=Viswanath D, Hegde R, Murthy V, et al. Red cell distribution width in the diagnosis of iron deficiency anemia[J]. Indian J Pediatr, 2001, 68(12): 1117-1119., articleTitle=Red cell distribution width in the diagnosis of iron deficiency anemia, refAbstract=null), Reference(id=1211282637285626724, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2019, volume=25, issue=32, pageStart=4739, pageEnd=4748, url=null, language=null, rfNumber=[11], rfOrder=10, authorNames=Zhang FX, Li ZL, Zhang ZD, journalName=World J Gastroenterol, refType=null, unstructuredReference=Zhang FX, Li ZL, Zhang ZD, et al. Prognostic value of red blood cell distribution width for severe acute pancreatitis[J]. World J Gastroenterol, 2019, 25(32): 4739-4748., articleTitle=Prognostic value of red blood cell distribution width for severe acute pancreatitis, refAbstract=null), Reference(id=1211282637377901413, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2016, volume=4, issue=20, pageStart=399, pageEnd=null, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=Montagnana M, Danese E, journalName=Ann Transl Med, refType=null, unstructuredReference=Montagnana M, Danese E. Red cell distribution width and cancer[J]. Ann Transl Med, 2016, 4(20): 399., articleTitle=Red cell distribution width and cancer, refAbstract=null), Reference(id=1211282637440815974, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2017, volume=48, issue=4, pageStart=378, pageEnd=385, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Zhang T, Li J, Lin Y, journalName=Arch Med Res, refType=null, unstructuredReference=Zhang T, Li J, Lin Y, et al. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis[J]. Arch Med Res, 2017, 48(4): 378-385., articleTitle=Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis, refAbstract=null), Reference(id=1211282637524702055, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2014, volume=60, issue=8, pageStart=1351, pageEnd=1356, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=Sangoi MB, Guarda Ndos S, Rödel AP, journalName=Clin Lab, refType=null, unstructuredReference=Sangoi MB, Guarda Ndos S, Rödel AP, et al. Prognostic value of red blood cell distribution width in prediction of in-hospital mortality in patients with acute myocardial infarction[J]. Clin Lab, 2014, 60(8): 1351-1356., articleTitle=Prognostic value of red blood cell distribution width in prediction of in-hospital mortality in patients with acute myocardial infarction, refAbstract=null), Reference(id=1211282637587616616, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2013, volume=10, issue=4, pageStart=416, pageEnd=424, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=Seyhan EC, Özgül MA, Tutar N, journalName=COPD, refType=null, unstructuredReference=Seyhan EC, Özgül MA, Tutar N, et al. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease[J]. COPD, 2013, 10(4): 416-424., articleTitle=Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease, refAbstract=null), Reference(id=1211282637658919785, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2020, volume=30, issue=12, pageStart=22, pageEnd=26, url=null, language=null, rfNumber=[16], rfOrder=15, authorNames=Li XH, Liu Y, Lv YC, journalName=Chin J Mod Med, refType=null, unstructuredReference=Li XH, Liu Y, Lv YC. Relation between levels of blood lactic acid, blood lactic acid clearance rate and red blood cell distribution width in sepsis patients and prognosis[J]. Chin J Mod Med, 2020, 30(12): 22-26., articleTitle=Relation between levels of blood lactic acid, blood lactic acid clearance rate and red blood cell distribution width in sepsis patients and prognosis, refAbstract=null), Reference(id=1211282637717640042, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2020, volume=30, issue=12, pageStart=22, pageEnd=26, url=null, language=null, rfNumber=[16], rfOrder=16, authorNames=李兴华, 刘颖, 吕艳超, journalName=中国现代医学杂志, refType=null, unstructuredReference=[李兴华, 刘颖, 吕艳超. 脓毒血症患者乳酸清除率、红细胞分布宽度和血乳酸水平及与预后的关系[J]. 中国现代医学杂志, 2020, 30(12): 22-26.], articleTitle=脓毒血症患者乳酸清除率、红细胞分布宽度和血乳酸水平及与预后的关系, refAbstract=null), Reference(id=1211282638925599595, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2013, volume=31, issue=3, pageStart=545, pageEnd=548, url=null, language=null, rfNumber=[17], rfOrder=17, authorNames=Jo YH, Kim K, Lee JH, journalName=Am J Emerg Med, refType=null, unstructuredReference=Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock[J]. Am J Emerg Med, 2013, 31(3): 545-548., articleTitle=Red cell distribution width is a prognostic factor in severe sepsis and septic shock, refAbstract=null), Reference(id=1211282638996902764, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2014, volume=9, issue=8, pageStart=e105436, pageEnd=null, url=null, language=null, rfNumber=[18], rfOrder=18, authorNames=Lorente L, Martín MM, Abreu-González P, journalName=PLoS One, refType=null, unstructuredReference=Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients[J]. PLoS One, 2014, 9(8): e105436., articleTitle=Red blood cell distribution width during the first week is associated with severity and mortality in septic patients, refAbstract=null), Reference(id=1211282639064011629, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2015, volume=59, issue=4, pageStart=379, pageEnd=385, url=null, language=null, rfNumber=[19], rfOrder=19, authorNames=Vayá A, Sarnago A, Fuster O, journalName=Clin Hemorheol Microcirc, refType=null, unstructuredReference=Vayá A, Sarnago A, Fuster O, et al. Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population[J]. Clin Hemorheol Microcirc, 2015, 59(4): 379-385., articleTitle=Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population, refAbstract=null), Reference(id=1211282639135314798, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2012, volume=25, issue=4, pageStart=609, pageEnd=634, url=null, language=null, rfNumber=[20], rfOrder=20, authorNames=Reinhart K, Bauer M, Riedemann NC, journalName=Clin Microbiol Rev, refType=null, unstructuredReference=Reinhart K, Bauer M, Riedemann NC, et al. New approaches to sepsis: molecular diagnostics and biomarkers[J]. Clin Microbiol Rev, 2012, 25(4): 609-634., articleTitle=New approaches to sepsis: molecular diagnostics and biomarkers, refAbstract=null), Reference(id=1211282639202423663, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2017, volume=211, issue=null, pageStart=14, pageEnd=20, url=null, language=null, rfNumber=[21], rfOrder=21, authorNames=Yuan T, Cong Y, Meng J, journalName=J Surg Res, refType=null, unstructuredReference=Yuan T, Cong Y, Meng J, et al. Arachidonic acid causes hidden blood loss-like red blood cell damage through oxidative stress reactions[J]. J Surg Res, 2017, 211: 14-20., articleTitle=Arachidonic acid causes hidden blood loss-like red blood cell damage through oxidative stress reactions, refAbstract=null), Reference(id=1211282639265338224, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2018, volume=65, issue=null, pageStart=244, pageEnd=247, url=null, language=null, rfNumber=[22], rfOrder=22, authorNames=Subramani K, Raju SP, Chu XG, journalName=Int Immunopharmacol, refType=null, unstructuredReference=Subramani K, Raju SP, Chu XG, et al. Effect of plasma-derived extracellular vesicles on erythrocyte deformability in polymicrobial sepsis[J]. Int Immunopharmacol, 2018, 65: 244-247., articleTitle=Effect of plasma-derived extracellular vesicles on erythrocyte deformability in polymicrobial sepsis, refAbstract=null), Reference(id=1211282639328252785, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2012, volume=302, issue=8, pageStart=F1045, pageEnd=F1054, url=null, language=null, rfNumber=[23], rfOrder=23, authorNames=Souza AC, Volpini RA, Shimizu MH, journalName=Am J Physiol Renal Physiol, refType=null, unstructuredReference=Souza AC, Volpini RA, Shimizu MH, et al. Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase[J]. Am J Physiol Renal Physiol, 2012, 302(8): F1045-F1054., articleTitle=Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase, refAbstract=null), Reference(id=1211282639407944562, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2014, volume=4, issue=4, pageStart=278, pageEnd=282, url=null, language=null, rfNumber=[24], rfOrder=24, authorNames=Mahmood NA, Mathew J, Kang B, journalName=Int J Crit Illn Inj Sci, refType=null, unstructuredReference=Mahmood NA, Mathew J, Kang B, et al. Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis[J]. Int J Crit Illn Inj Sci, 2014, 4(4): 278-282., articleTitle=Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis, refAbstract=null), Reference(id=1211282639475053427, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2016, volume=42, issue=16, pageStart=1788, pageEnd=1791, url=null, language=null, rfNumber=[25], rfOrder=25, authorNames=Tan C, Li M, Wang SY, journalName=Jiangsu Med J, refType=null, unstructuredReference=Tan C, Li M, Wang SY. Value of red cell distribution width in evaluating prognosis of patients with sepsis[J]. Jiangsu Med J, 2016, 42(16): 1788-1791., articleTitle=Value of red cell distribution width in evaluating prognosis of patients with sepsis, refAbstract=null), Reference(id=1211282639550550900, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2016, volume=42, issue=16, pageStart=1788, pageEnd=1791, url=null, language=null, rfNumber=[25], rfOrder=26, authorNames=谈晨, 李梅, 王胜云, journalName=江苏医药, refType=null, unstructuredReference=[谈晨, 李梅, 王胜云. 红细胞分布宽度对脓毒症患者预后评估的价值[J]. 江苏医药, 2016, 42(16): 1788-1791.], articleTitle=红细胞分布宽度对脓毒症患者预后评估的价值, refAbstract=null), Reference(id=1211282639630242677, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2015, volume=21, issue=2, pageStart=168, pageEnd=170, url=null, language=null, rfNumber=[26], rfOrder=27, authorNames=Zhao JJ, Chai YF, Zhang XK, journalName=J Tianjin Med Univ, refType=null, unstructuredReference=Zhao JJ, Chai YF, Zhang XK. The predictive value of red blood cell distribution width in the prognosis of patients with septic shock[J]. J Tianjin Med Univ, 2015, 21(2): 168-170., articleTitle=The predictive value of red blood cell distribution width in the prognosis of patients with septic shock, refAbstract=null), Reference(id=1211282639697351542, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2015, volume=21, issue=2, pageStart=168, pageEnd=170, url=null, language=null, rfNumber=[26], rfOrder=28, authorNames=赵静静, 柴艳芬, 张晓堃, journalName=天津医科大学学报, refType=null, unstructuredReference=[赵静静, 柴艳芬, 张晓堃. 红细胞分布宽度对脓毒症休克患者预后的预测价值[J]. 天津医科大学学报, 2015, 21(2): 168-170.], articleTitle=红细胞分布宽度对脓毒症休克患者预后的预测价值, refAbstract=null), Reference(id=1211282639760266103, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2018, volume=36, issue=6, pageStart=949, pageEnd=953, url=null, language=null, rfNumber=[27], rfOrder=29, authorNames=Wang AY, Ma HP, Kao WF, journalName=Am J Emerg Med, refType=null, unstructuredReference=Wang AY, Ma HP, Kao WF, et al. Red blood cell distribution width is associated with mortality in elderly patients with sepsis[J]. Am J Emerg Med, 2018, 36(6): 949-953., articleTitle=Red blood cell distribution width is associated with mortality in elderly patients with sepsis, refAbstract=null), Reference(id=1211282639839957880, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2018, volume=2, issue=5, pageStart=279, pageEnd=284, url=null, language=null, rfNumber=[28], rfOrder=30, authorNames=Peng F, Jian J, Zhang HL, journalName=J Pract Shock, refType=null, unstructuredReference=Peng F, Jian J, Zhang HL, et al. The value of PDW, RDW, MCV in severity and prognosis evaluation of sepsis[J]. J Pract Shock, 2018, 2(5): 279-284., articleTitle=The value of PDW, RDW, MCV in severity and prognosis evaluation of sepsis, refAbstract=null), Reference(id=1211282639907066745, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, doi=null, pmid=null, pmcid=null, year=2018, volume=2, issue=5, pageStart=279, pageEnd=284, url=null, language=null, rfNumber=[28], rfOrder=31, authorNames=彭菲, 简娟, 张宏亮, journalName=实用休克杂志, refType=null, unstructuredReference=[彭菲, 简娟, 张宏亮, 等. PDW、RDW和MCV在评估脓毒症严重程度及预后中的价值[J]. 实用休克杂志, 2018, 2(5): 279-284.], articleTitle=PDW、RDW和MCV在评估脓毒症严重程度及预后中的价值, refAbstract=null)], funds=[Fund(id=1211282636081861462, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, awardId=81701890, language=EN, fundingSource=National Natural Science Foundation of China(81701890), fundOrder=null, country=null), Fund(id=1211282636144776023, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, awardId=81701890, language=CN, fundingSource=国家自然科学基金青年科学基金(81701890), fundOrder=null, country=null), Fund(id=1211282636224467800, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, awardId=17BJZ17, language=EN, fundingSource=Special Topic of PLA Health Care(17BJZ17), fundOrder=null, country=null), Fund(id=1211282636291576665, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, awardId=17BJZ17, language=CN, fundingSource=全军保健专项课题(17BJZ17), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1211282631153554201, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, xref=null, ext=[AuthorCompanyExt(id=1211282631161942810, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, companyId=1211282631153554201, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=First Department of Cadre's Ward, General Hospital of Eastern Theater Command of PLA, Nanjing 210002, China), AuthorCompanyExt(id=1211282631170331419, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, companyId=1211282631153554201, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=解放军东部战区总医院干部病房一科，南京 210002)])], figs=[ArticleFig(id=1211282634911650632, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Fig.1, caption=Scatterplot of the correlation between RDW and APACHE Ⅱ score, SOFA score, total hospitalization time and ICU stay in sepsis patients, figureFileSmall=v64n0Ie5+w1u0zXzGowj7w==, figureFileBig=bK5CzjTlq7L0Sm7rvFNY5Q==, tableContent=null), ArticleFig(id=1211282634999731017, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=图1, caption=脓毒症患者RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间的相关性

APACHE. 急性生理与慢性健康评分；SOFA. 序贯器官衰竭评分；RDW. 红细胞分布宽度

, figureFileSmall=v64n0Ie5+w1u0zXzGowj7w==, figureFileBig=bK5CzjTlq7L0Sm7rvFNY5Q==, tableContent=null), ArticleFig(id=1211282635104588618, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Fig.2, caption=ROC curves of forecasting the risk factors of septic shock in elderly sepsis patients, figureFileSmall=fdgUJJlTIFSyvyX9U8Kz7A==, figureFileBig=tjYomFSdpfy5qqZOUwuhkA==, tableContent=null), ArticleFig(id=1211282635163308875, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=图2, caption=RDW预测老年脓毒症患者发生脓毒性休克的ROC曲线

RDW. 红细胞分布宽度；SOFA. 序贯器官衰竭评分

, figureFileSmall=fdgUJJlTIFSyvyX9U8Kz7A==, figureFileBig=tjYomFSdpfy5qqZOUwuhkA==, tableContent=null), ArticleFig(id=1211282635230417740, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Fig.3, caption=ROC curves of forecasting the risk factors of severe MODS in elderly sepsis patients, figureFileSmall=6eszvbJzwpFxzSyG8i3RAQ==, figureFileBig=mQfnwAc6oPCe8RfKvHiPig==, tableContent=null), ArticleFig(id=1211282635305915213, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=图3, caption=RDW预测老年脓毒症患者发生重度器官功能障碍的ROC曲线

RDW. 红细胞分布宽度；APACHE. 急性生理与慢性健康评分

, figureFileSmall=6eszvbJzwpFxzSyG8i3RAQ==, figureFileBig=mQfnwAc6oPCe8RfKvHiPig==, tableContent=null), ArticleFig(id=1211282635364635470, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Tab.1, caption=

General information of 210 elderly patients with sepsis

, figureFileSmall=null, figureFileBig=null, tableContent=
类别数值
脓毒症原因[例(%)]
 肺部感染120(57.1)
 腹腔感染55(26.2)
 肝胆系统感染12(5.7)
 皮肤软组织感染4(1.9)
 胃肠道感染2(0.9)
 多部位感染17(8.1)
受累器官[例(%)]
 呼吸系统206(98.1)
 凝血系统112(53.3)
 肝脏104(49.5)
 心血管系统96(45.7)
 中枢神经系统95(45.2)
 肾脏91(43.3)
住院期间发生重度器官功能障碍[例(%)]79(37.6)
既往史[例(%)]
 高血压109(51.9)
 2型糖尿病49(23.3)
 脑梗死35(16.7)
 冠心病28(13.3)
 COPD21(10.0)
 房颤16(7.6)
 肿瘤11(5.2)
RDW (%,$\bar{x}±s$)17.31±3.81
APACHE Ⅱ评分(分，$\bar{x}±s$)24.32±9.61
SOFA评分(分，$\bar{x}±s$)8.68±5.97
住院总时间[d，M(P25，P75)]29.5(15.0，45.3)
住ICU时间[d，M(P25，P75)]16(8.8，30.0)
住院期间发生脓毒性休克[例(%)]93(44.3)
住院期间死亡[例(%)]60(28.6)
), ArticleFig(id=1211282635431744335, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=表1, caption=

210例老年脓毒症患者一般资料

, figureFileSmall=null, figureFileBig=null, tableContent=
类别数值
脓毒症原因[例(%)]
 肺部感染120(57.1)
 腹腔感染55(26.2)
 肝胆系统感染12(5.7)
 皮肤软组织感染4(1.9)
 胃肠道感染2(0.9)
 多部位感染17(8.1)
受累器官[例(%)]
 呼吸系统206(98.1)
 凝血系统112(53.3)
 肝脏104(49.5)
 心血管系统96(45.7)
 中枢神经系统95(45.2)
 肾脏91(43.3)
住院期间发生重度器官功能障碍[例(%)]79(37.6)
既往史[例(%)]
 高血压109(51.9)
 2型糖尿病49(23.3)
 脑梗死35(16.7)
 冠心病28(13.3)
 COPD21(10.0)
 房颤16(7.6)
 肿瘤11(5.2)
RDW (%,$\bar{x}±s$)17.31±3.81
APACHE Ⅱ评分(分，$\bar{x}±s$)24.32±9.61
SOFA评分(分，$\bar{x}±s$)8.68±5.97
住院总时间[d，M(P25，P75)]29.5(15.0，45.3)
住ICU时间[d，M(P25，P75)]16(8.8，30.0)
住院期间发生脓毒性休克[例(%)]93(44.3)
住院期间死亡[例(%)]60(28.6)
), ArticleFig(id=1211282635503047504, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Tab.2, caption=

Comparison of the clinical data among different groups of patients with sepsis

, figureFileSmall=null, figureFileBig=null, tableContent=
指标脓毒性休克组(n=93)非休克组(n=117)t/Z/χ2P重度器官功能障碍组(n=79)轻度器官功能障碍组(n=131)t/Z/χ2P死亡组(n=60)存活组(n=150)t/Z/χ2P
年龄(岁，$\bar{x}±s$)71.7±8.971.8±8.20.1720.86471.9±9.371.7±8.2–0.2040.83872.6±9.471.5±8.2–0.8590.392
性别(男/女，例)67/2680/370.3320.56557/2290/410.2790.57940/20107/430.4440.505
吸烟史[例(%)]34(36.6)39(33.3)0.2380.62627(34.2)46(35.1)0.0190.8919(31.7)54(36.0)0.3550.551
饮酒史[例(%)]21(22.6)24(20.5)0.1320.71718(22.8)27(20.6)0.1380.7112(20.0)33(22.0)0.1020.75
APACHEⅡ评分(分，$\bar{x}±s$)32.16±8.2318.09±4.93–15.352<0.00134.47±6.9118.21±4.23–20.795<0.00136.42±6.0219.50±5.73–19.041<0.001
SOFA评分(分，$\bar{x}±s$)13.96±4.674.49±2.61–18.589<0.00115.49±3.384.57±2.28–27.943<0.00116.13±3.585.71±3.69–18.664<0.001
RDW (%)18.73±3.9716.18±3.28–5.098<0.00119.66±4.4415.90±2.48–6.899<0.00119.19±4.1716.58±3.39–4.310<0.001
住院总时间[d，M(P25，P75)]32(16，49)26(14，45)–1.6510.09435(19，49)26(14，42)–2.0130.03834(14，49)28(15，45)–1.0990.249
住ICU时间[d，M(P25，P75)]22(13，40)14(6，26)–3.488<0.00125(15，40)13(6，26)–3.506<0.00125(13，40)15(8，27)–2.4620.009
脓毒性休克[例(%)]–– –74(93.7)19(14.5)125.181<0.00156(93.3)37(24.7)81.9<0.001
重度器官功能障碍[例(%)]74(79.6)5(4.3)125.181<0.001–– –57(95.0)22(14.7)104.562<0.001
死亡[例(%)]56(60.2)4(3.4)81.9<0.00157(72.15)3(2.29)117.857<0.001–– –
既往史[例(%)]            
 高血压病47(50.5)62(52.9)0.1250.72445(56.9)64(48.9)1.2970.25535(58.3)74(49.3)1.3910.238
 2型糖尿病19(20.4)30(25.6)0.7860.37519(24.1)30(22.9)0.0360.84917(28.3)32(21.3)1.1740.279
 脑梗死12(12.9)23(19.7)1.7020.19212(15.2)23(17.6)0.1990.6568(13.3)27(18.0)0.6720.412
 冠心病13(13.9)15(12.8)0.060.80612(15.2)16(12.2)0.3780.53911(18.3)17(11.3)1.8170.178
 COPD6(6.5)15(12.8)2.3350.1266(7.6)15(11.5)0.8140.3675(8.3)16(10.7)0.2590.611
 房颤6(6.5)10(8.6)0.3230.575(6.3)11(8.4)0.2990.5845(8.3)11(7.3)0.0610.805
 肿瘤9(9.7)2(1.7)6.6270.016(7.6)5(3.8)1.4170.2343(5.0)8(5.3)0.010.922
), ArticleFig(id=1211282635607905105, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=表2, caption=

脓毒症患者不同临床转归组间临床资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标脓毒性休克组(n=93)非休克组(n=117)t/Z/χ2P重度器官功能障碍组(n=79)轻度器官功能障碍组(n=131)t/Z/χ2P死亡组(n=60)存活组(n=150)t/Z/χ2P
年龄(岁，$\bar{x}±s$)71.7±8.971.8±8.20.1720.86471.9±9.371.7±8.2–0.2040.83872.6±9.471.5±8.2–0.8590.392
性别(男/女，例)67/2680/370.3320.56557/2290/410.2790.57940/20107/430.4440.505
吸烟史[例(%)]34(36.6)39(33.3)0.2380.62627(34.2)46(35.1)0.0190.8919(31.7)54(36.0)0.3550.551
饮酒史[例(%)]21(22.6)24(20.5)0.1320.71718(22.8)27(20.6)0.1380.7112(20.0)33(22.0)0.1020.75
APACHEⅡ评分(分，$\bar{x}±s$)32.16±8.2318.09±4.93–15.352<0.00134.47±6.9118.21±4.23–20.795<0.00136.42±6.0219.50±5.73–19.041<0.001
SOFA评分(分，$\bar{x}±s$)13.96±4.674.49±2.61–18.589<0.00115.49±3.384.57±2.28–27.943<0.00116.13±3.585.71±3.69–18.664<0.001
RDW (%)18.73±3.9716.18±3.28–5.098<0.00119.66±4.4415.90±2.48–6.899<0.00119.19±4.1716.58±3.39–4.310<0.001
住院总时间[d，M(P25，P75)]32(16，49)26(14，45)–1.6510.09435(19，49)26(14，42)–2.0130.03834(14，49)28(15，45)–1.0990.249
住ICU时间[d，M(P25，P75)]22(13，40)14(6，26)–3.488<0.00125(15，40)13(6，26)–3.506<0.00125(13，40)15(8，27)–2.4620.009
脓毒性休克[例(%)]–– –74(93.7)19(14.5)125.181<0.00156(93.3)37(24.7)81.9<0.001
重度器官功能障碍[例(%)]74(79.6)5(4.3)125.181<0.001–– –57(95.0)22(14.7)104.562<0.001
死亡[例(%)]56(60.2)4(3.4)81.9<0.00157(72.15)3(2.29)117.857<0.001–– –
既往史[例(%)]            
 高血压病47(50.5)62(52.9)0.1250.72445(56.9)64(48.9)1.2970.25535(58.3)74(49.3)1.3910.238
 2型糖尿病19(20.4)30(25.6)0.7860.37519(24.1)30(22.9)0.0360.84917(28.3)32(21.3)1.1740.279
 脑梗死12(12.9)23(19.7)1.7020.19212(15.2)23(17.6)0.1990.6568(13.3)27(18.0)0.6720.412
 冠心病13(13.9)15(12.8)0.060.80612(15.2)16(12.2)0.3780.53911(18.3)17(11.3)1.8170.178
 COPD6(6.5)15(12.8)2.3350.1266(7.6)15(11.5)0.8140.3675(8.3)16(10.7)0.2590.611
 房颤6(6.5)10(8.6)0.3230.575(6.3)11(8.4)0.2990.5845(8.3)11(7.3)0.0610.805
 肿瘤9(9.7)2(1.7)6.6270.016(7.6)5(3.8)1.4170.2343(5.0)8(5.3)0.010.922
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Logistic regression analysis of the correlation of RDW and clinical outcome of elderly patients with sepsis

, figureFileSmall=null, figureFileBig=null, tableContent=
因素脓毒性休克重度器官功能障碍死亡
OR(95%CI)POR(95%CI)POR(95%CI)P
RDW1.23(1.12~1.34)0.0381.41(1.09~1.83)0.0090.89(0.78~1.02)0.098
APACHE Ⅱ评分1.05(0.94~1.18)0.3591.45(1.24~1.71)<0.0011.27(1.10~1.45)0.001
SOFA评分1.88(1.46~2.40)<0.001––1.46(1.13~1.88)0.004
脓毒性休克––34.38(5.19~227.70)<0.0010.67(0.11~3.93)0.657
), ArticleFig(id=1211282635813426003, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=表3, caption=

Logistic回归分析RDW与老年脓毒症患者临床转归的关系

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因素脓毒性休克重度器官功能障碍死亡
OR(95%CI)POR(95%CI)POR(95%CI)P
RDW1.23(1.12~1.34)0.0381.41(1.09~1.83)0.0090.89(0.78~1.02)0.098
APACHE Ⅱ评分1.05(0.94~1.18)0.3591.45(1.24~1.71)<0.0011.27(1.10~1.45)0.001
SOFA评分1.88(1.46~2.40)<0.001––1.46(1.13~1.88)0.004
脓毒性休克––34.38(5.19~227.70)<0.0010.67(0.11~3.93)0.657
), ArticleFig(id=1211282635876340564, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=EN, label=Tab.4, caption=

Logistic regression analysis of the correlation between RDW>20% and clinical outcome of elderly patients with sepsis

, figureFileSmall=null, figureFileBig=null, tableContent=
因素脓毒性休克重度器官功能障碍
OR(95%CI)POR(95%CI)P
RDW>20%2.15(1.88~5.16)0.0397.94(1.16~54.46)0.035
APACHE Ⅱ评分1.05(0.94~1.18)0.3651.43(1.23~1.65)<0.001
SOFA评分1.87(1.46~2.39)<0.001––
脓毒性休克––27.39(4.89~153.53)<0.001
), ArticleFig(id=1211282635943449429, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1210676791014985879, language=CN, label=表4, caption=

Logistic回归分析RDW>20%与老年脓毒症患者临床转归的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
因素脓毒性休克重度器官功能障碍
OR(95%CI)POR(95%CI)P
RDW>20%2.15(1.88~5.16)0.0397.94(1.16~54.46)0.035
APACHE Ⅱ评分1.05(0.94~1.18)0.3651.43(1.23~1.65)<0.001
SOFA评分1.87(1.46~2.39)<0.001––
脓毒性休克––27.39(4.89~153.53)<0.001
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红细胞分布宽度对老年脓毒症患者临床转归的评估价值
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杨晨 , 郭蕾 , 黄方 , 陈阳希 , 严妤函 , 万文辉 , 刘瑜 *
解放军医学杂志 | 临床研究 2021,46(5): 474-480
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解放军医学杂志 | 临床研究 2021, 46(5): 474-480
红细胞分布宽度对老年脓毒症患者临床转归的评估价值
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杨晨, 郭蕾, 黄方, 陈阳希, 严妤函, 万文辉, 刘瑜*
作者信息
  • 解放军东部战区总医院干部病房一科，南京 210002

    • 杨晨，硕士研究生，主要从事老年内分泌疾病的临床与基础研究

通讯作者:

刘瑜，E-mail：
The value of red cell volume distribution width in evaluating the clinical outcome of sepsis in the elderly
Chen Yang, Lei Guo, Fang Huang, Yang-Xi Chen, Yu-Han Yan, Wen-hui Wan, Yu Liu*
Affiliations
  • First Department of Cadre's Ward, General Hospital of Eastern Theater Command of PLA, Nanjing 210002, China
出版时间: 2021-05-28 doi: 10.11855/j.issn.0577-7402.2021.05.08
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摘要
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目的 探讨红细胞分布宽度(RDW)对老年脓毒症患者临床转归的预测价值。方法 纳入2018年1月—2019年12月东部战区总医院收治的210例老年脓毒症患者，计算脓毒症期间最高急性生理与慢性健康状态评分Ⅱ(APACHE Ⅱ)及序贯器官衰竭评分(SOFA)。根据住院期间临床转归情况，将210例患者分为脓毒性休克组(n=93)与非休克组(n=117)；根据治疗结局，将患者分为死亡组(n=60)与存活组(n=150)；根据SOFA评分将患者分为重度器官功能障碍组(SOFA≥10分，n=79)及轻度器官功能障碍组(SOFA<10分，n=131)。比较各组年龄、性别、吸烟史、饮酒史、既往史、APACHE Ⅱ评分、SOFA评分、RDW等指标的差异，采用Spearman相关分析RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间的相关性，采用非条件logistic回归分析老年脓毒症患者发生脓毒性休克、重度器官功能障碍及死亡的危险因素，采用受试者工作特征(ROC)曲线分析RDW、SOFA评分、APACHE Ⅱ评分对老年脓毒症患者发生脓毒性休克、重度器官功能障碍的预测价值。结果 脓毒性休克组RDW、APACHE Ⅱ评分、SOFA评分、重度器官功能障碍及死亡的发生率均高于非休克组，重度器官功能障碍组RDW、APACHE Ⅱ评分、脓毒性休克及死亡的发生率均高于轻度器官功能障碍组，死亡组RDW、APACHE Ⅱ评分、SOFA评分、脓毒性休克及重度器官功能障碍的发生率均高于存活组，差异有统计学意义(P<0.05)；RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间呈正相关(P<0.001)；RDW升高是脓毒性休克、重度器官功能障碍的独立危险因素(P<0.05)；RDW>20%的脓毒症患者发生脓毒性休克及重度器官功能障碍的风险明显升高(P<0.05)；SOFA评分预测脓毒性休克的ROC曲线下面积(AUC)为0.958，敏感度为0.817，特异度为0.940，RDW联合SOFA评分的AUC为0.959，敏感度为0.968，特异度为0.676；APACHE Ⅱ评分预测重度器官功能障碍的AUC为0.973，敏感度为0.911，特异度为0.931，RDW联合APACHE Ⅱ评分的AUC为0.978，敏感度为0.972，特异度为0.668。结论 RDW升高是预测老年脓毒症患者发生脓毒性休克及重度器官功能障碍的独立危险因素；RDW联合SOFA评分预测脓毒性休克及RDW联合APACHE Ⅱ评分预测重度器官功能障碍的敏感度均优于单个指标。

红细胞分布宽度  /  老年脓毒症  /  脓毒性休克  /  重度器官功能障碍

Objective To explore the predictive value of red volume distribution width (RDW) for the clinical outcome of sepsis in the elderly. Methods Two hundred and ten elderly patients with sepsis admitted to the General Hospital of Eastern Theater Command of PLA from January 2018 to December 2019 were included. The highest Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score and sequential organ failure (SOFA) score were calculated during sepsis. According to clinical outcome, 210 patients were divided into septic shock (n=93) /non-shock (n=117) groups; severe (n=79)/mild organ dysfunction (n=131) groups and death (n=60)/survival groups (n=150). The differences in age, sex, smoking and drinking history, medical history, APACHE Ⅱ score, SOFA score, RDW were compared between the different groups. Spearman's correlation analysis was used to analyze the correlation between RDW and APACHE Ⅱscore, SOFA score, total hospital days and ICU hospital days. Unconditional logistic regression was used to analyze the risk factors for septic shock, severe organ dysfunction and death in elderly patients with sepsis. Receiver operating characteristic (ROC) curves were adopted to analyze the predictive value of RDW, SOFA score, and APACHE Ⅱ score for septic shock and severe organ dysfunction in elderly patients with sepsis. Results The RDW, APACHE Ⅱ score, SOFA score, the incidence of severe organ dysfunction and death in the septic shock group were higher than those of the non-sepsis group; RDW, APACHE Ⅱscore, SOFA score, the incidences of septic shock and mortality in the severe organ dysfunction group were higher than those in the mild organ dysfunction group; RDW, APACHE Ⅱ score, SOFA score, the incidence of septic shock and severe organ dysfunction in the death group were higher than those in the survival group, there was a significant difference between each group (P<0.05); RDW was positively correlated with APACHE Ⅱ score, SOFA score, total hospital days and ICU hospital days (P<0.001); Elevated RDW was an independent risk factor for septic shock and severe organ dysfunction (P<0.05); the risk of septic shock and severe organ dysfunction was significantly increased when RDW>20% (P<0.05); The ROC AUC of SOFA score was 0.958, sensitivity was 0.817, specificity was 0.940, ROC AUC of RDW combined with SOFA score was 0.959, sensitivity was 0.968, specificity was 0.676 in predicting septic shock; The ROC AUC of APACHE Ⅱ score was 0.973, sensitivity was 0.911, specificity was 0.931, the ROC AUC of the RDW combined with APACHE Ⅱ score was 0.978, sensitivity was 0.972, and specificity was 0.668 in predicting severe organ dysfunction. Conclusions RDW is an independent risk factor to predict septic shock and severe organ dysfunction in elderly patients with sepsis; RDW combined with SOFA score and RDW combined with APACHE Ⅱ score have better sensitivity to predict septic shock and severe organ dysfunction than any single factor.

red cell volume distribution width  /  sepsis, elderly  /  septic shock  /  severe organ dysfunction
杨晨, 郭蕾, 黄方, 陈阳希, 严妤函, 万文辉, 刘瑜. 红细胞分布宽度对老年脓毒症患者临床转归的评估价值. 解放军医学杂志, 2021 , 46 (5) : 474 -480 . DOI: 10.11855/j.issn.0577-7402.2021.05.08
Chen Yang, Lei Guo, Fang Huang, Yang-Xi Chen, Yu-Han Yan, Wen-hui Wan, Yu Liu. The value of red cell volume distribution width in evaluating the clinical outcome of sepsis in the elderly[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (5) : 474 -480 . DOI: 10.11855/j.issn.0577-7402.2021.05.08
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脓毒症是机体对感染产生广泛而失控的炎症反应所导致的一种复杂的临床综合征[1]，脓毒症及其严重并发症是目前危重患者死亡的首要原因。老年患者免疫力低下，基础疾病多，感染后临床症状不典型，容易漏诊或误诊，一旦发生脓毒症其病死率可高达60%以上。因此，寻找可早期评估脓毒症病情的生物标志物，有利于早期识别、干预危重脓毒症患者并改善其预后。红细胞分布宽度(RDW)是反映红细胞体积异质性的血液学指标，是危重患者全因病死率及血流感染风险的可靠预测因子[2]。革兰阴性菌是脓毒症的主要致病原，而RDW是革兰阴性菌菌血症患者死亡的独立预测因子[3]。现有研究多涉及RDW与脓毒症患者死亡结局的相关性，但少有RDW与脓毒症不同临床转归(包括脓毒性休克、重度器官功能障碍及死亡)关系的研究。本研究探讨RDW对老年脓毒症患者病情严重程度及预后的预测价值。
1 资料与方法
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1.1 一般资料
回顾性分析2018年1月—2019年12月解放军东部战区总医院呼吸与危重症医学科ICU及普通外科ICU收治的210例老年脓毒症患者的临床资料，其中男147例，女63例，年龄(71.8±8.6)岁，其他资料见表1。参照2016年美国重症医学会(SCCM)与欧洲重症医学会(ESICM)联合发布的脓毒症的新标准(Sepsis 3.0)诊断脓毒症及脓毒性休克。脓毒症：感染+序贯器官衰竭评分(SOFA)≥2分。脓毒性休克：在脓毒症基础上，尽管给予充分的液体复苏，仍需用升压药维持平均动脉压≥65 mmHg，且血乳酸水平>2 mmol/L[1]。纳入标准：(1)脓毒症诊断明确；(2)年龄≥60岁；(3)病例资料及检查结果齐全；(4)参照2017年1月SCCM与ESICM联合发布的脓毒症及脓毒性休克处理国际指南(2016)[4]进行治疗。排除标准：(1)入院后24 h内死亡；(2)患有中度/重度贫血；(3)应用可能影响造血系统的药物；(4)血液病如地中海贫血家族史；(5)严重肝肾功能不全；(6)发病前与发病后3 d内有输血史。
1.2 研究方法
收集所有入组患者的人口学资料，吸烟、饮酒史，既往史，诊断脓毒症后3 d内最大RDW值，住院总时间及住ICU时间等。根据诊断脓毒症的生命体征及实验室检查结果，计算脓毒症期间最高APACHE Ⅱ评分及SOFA评分。根据住院期间的临床转归情况，将210例患者分为脓毒性休克组(n=93)与非休克组(n=117)；根据治疗结局，将患者分为死亡组(n=60)与存活组(n=150)；根据SOFA评分将患者分为重度器官功能障碍组(SOFA≥10分，n=79)及轻度器官功能障碍组(SOFA<10分，n=131)。比较不同临床转归组间RDW的差异，研究RDW与脓毒性休克、重度器官功能障碍及死亡的相关性及预测价值。
1.3 统计学处理
用SPSS 19.0软件对数据进行统计分析。计量资料行正态分布检验，符合正态分布者以$\bar{x}±s$表示，两组间比较采用t检验；不符合正态分布者以M(P25，P75)表示，两组间比较采用非参数检验方法。计数资料以例(%)表示，组间比较采用χ2检验。采用Spearman相关分析RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间的相关性，采用非条件logistic回归分析脓毒性休克、重度器官功能障碍及死亡的危险因素，采用ROC曲线评价RDW对老年脓毒症患者临床转归的判断价值。P<0.05为差异有统计学意义。
2 结果
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2.1 脓毒症患者RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间的相关性
Spearman相关分析显示，RDW与APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间均呈正相关(P<0.01，图1)。
2.2 RDW与脓毒性休克的关系
脓毒性休克组与非休克组的年龄、性别、吸烟史、饮酒史差异无统计学意义(P>0.05)；与非休克组比较，脓毒性休克组具有较高的RDW值、APACHE Ⅱ评分、SOFA评分、住ICU时间、重度器官功能障碍发生率、死亡发生率，且肿瘤病史比例也较高，差异有统计学意义(P<0.05)(表2)。以脓毒性休克为因变量(无=0，有=1)，以单因素分析结果差异有统计学意义的指标为自变量进行logistic多因素回归分析，结果显示RDW升高、SOFA评分高是老年脓毒症患者发生脓毒性休克的独立危险因素(表3)。进一步将RDW值是否大于20%(否=0，是=1)作为自变量进行logistic回归分析，结果显示RDW>20%的患者发生脓毒性休克的风险明显升高(P=0.039，表4)。
2.3 RDW与重度器官功能障碍的关系
重度与轻度器官功能障碍组的年龄、性别及吸烟史、饮酒史比例差异无统计学意义，重度器官功能障碍组的RDW、APACHE Ⅱ评分、SOFA评分、住院总时间、住ICU时间、脓毒性休克发生率、死亡发生率均高于轻度器官功能障碍组，差异有统计学意义(P<0.05，表2)。以重度器官功能障碍为因变量(无=0，有=1)，以单因素分析结果差异有统计学意义的指标为自变量进行logistic多因素回归分析，结果显示RDW升高、APACHE Ⅱ评分高、发生脓毒性休克是重度器官功能障碍的独立危险因素(表3)。进一步将RDW值是否大于20%(否=0，是=1)作为自变量进行logistic回归分析，结果显示RDW>20%的患者发生重度器官功能障碍的风险明显升高(P=0.035，表4)。
2.4 RDW与死亡的关系
住院期间死亡组与存活组的年龄、性别及吸烟史、饮酒史比例差异无统计学意义，死亡组的RDW、APACHE Ⅱ评分、SOFA评分、住ICU时间、脓毒性休克发生率、重度器官功能障碍发生率均高于存活组，差异有统计学意义(P<0.05，表2)。以死亡与否为因变量(无=0，有=1)，以单因素分析结果差异有统计学意义的指标为自变量进行logistic多因素回归分析，结果显示APACHE Ⅱ评分高、SOFA评分高是脓毒症患者死亡的独立危险因素(表3)。
2.5 RDW预测老年脓毒症患者发生脓毒性休克及重度器官功能障碍的价值
ROC曲线结果显示，RDW预测脓毒性休克的曲线下面积(AUC)为0.726，敏感度0.828，特异度0.538；SOFA评分预测脓毒性休克的AUC为0.958，敏感度0.817，特异度0.940；RDW联合SOFA评分预测脓毒性休克的AUC为0.959，敏感度0.968，特异度0.676(图2)。RDW预测重度器官功能障碍的AUC为0.781，敏感度0.696，特异度0.718；APACHE Ⅱ评分预测重度器官功能障碍的AUC为0.973，敏感度0.911，特异度0.931；RDW联合APACHE Ⅱ评分预测重度器官功能障碍的AUC为0.978，敏感度0.972，特异度0.668(图3)。
3 讨论
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尽管有先进的诊断方法、广谱抗生素及重症监护，脓毒症仍是世界范围内因感染死亡的主要原因，许多生物标志物及多重评分系统被用来预测脓毒症患者的预后[5-9]，但因为敏感度及特异度均较低，实用性不强，检测、评估过程复杂等原因，使其不能广泛应用于临床。RDW是检测患者标准全血计数的一部分，临床上主要用于血液系统疾病的诊断，较高的RDW水平表明红细胞大小差异较大，可用于鉴别由铁、叶酸及维生素B12缺乏引起的营养缺乏性贫血[10]。RDW还与其他非血液系统疾病如胰腺炎[11]、恶性肿瘤[12]、慢性肾病[13]、心血管疾病[14]、COPD[15]等的不良预后相关。RDW与脓毒症的相关性已得到国内外研究者的关注。
本研究显示脓毒性休克组较非休克组、重度器官功能障碍组较轻度器官功能障碍组、死亡组较存活组有更高的RDW值，差异有统计学意义，与以往研究的结论一致[16-18]。RDW与脓毒症严重程度相关的机制可能是：(1)RDW的增加与一些急性炎症标志物(C反应蛋白、红细胞沉降率、白细胞介素-6、肿瘤坏死因子受体Ⅰ及Ⅱ)相关[19]，提示细胞大小差异反映了炎症反应的存在。炎症反应是脓毒症发病的主要机制，病原菌相关分子模式诱导的炎性细胞因子可直接诱导红细胞损伤，干扰铁稳态，诱导骨髓抑制，下调红细胞生成素受体的表达，导致脓毒症期间RDW升高[20]。(2)氧化应激也是脓毒症的主要病理机制之一，可降低红细胞存活率，致使大的、不成熟的红细胞释放进入外周循环，直接导致RDW升高[21]。(3)脓毒症改变了红细胞膜上的糖蛋白及离子通道，导致红细胞形态发生改变[22]。(4)肾脏是红细胞生成素的主要合成部位，脓毒症合并急性肾功能损伤者的红细胞生成素分泌不足也可引起RDW升高[23]。
Mahmood等[24]提出RDW≥16%与APACHE Ⅱ评分≥15分独立相关，谈晨等[25]的研究表明RDW与APACHE Ⅱ评分(r=0.426)、SOFA评分(r=0.445)均呈正相关，赵静静等[26]的研究表明RDW与APACHEⅡ评分呈正相关(r=0.546)，以上研究均提示RDW与脓毒症患者的病情严重程度相关。本研究Spearman相关分析结果显示，RDW与脓毒症患者APACHEⅡ评分、SOFA评分、住院总时间及住ICU时间均呈正相关，说明RDW可作为评价脓毒症病情严重程度及预后的指标。
Wang等[27]的研究显示，RDW可能是入住ICU的老年脓毒症患者死亡的独立影响因素，Lorente等[18]及赵静静等[26]的研究也得出RDW升高可预测严重脓毒症及脓毒性休克患者死亡的结论。本研究结果显示，RDW升高是老年脓毒症患者发生脓毒性休克及重度器官功能障碍的独立危险因素；诊断脓毒症后3 d内最大RDW>20%的老年脓毒症患者发生脓毒性休克及重度器官功能障碍的风险明显升高。但RDW并非是脓毒症患者死亡的影响因素，可能与以下因素有关：(1)本研究纳入样本数量较少；(2)虽然考虑了可能影响RDW的情况(如恶性血液病、严重肝肾功能不全)，但RDW还可能受到营养状况的影响，本研究没有考虑铁、维生素B12、叶酸的水平，因这些指标不是住院患者的常规检查项目；(3)老年患者常合并慢性肾功能不全，本研究并未纳入患者的红细胞生成素指标。因此，后续可扩大样本量，采用前瞻性研究充分纳入RDW的影响因素，多时间点动态监测RDW，深入探讨RDW与老年脓毒症患者住院死亡的关系。
本研究采用ROC曲线分析RDW、SOFA评分对脓毒症患者严重程度的诊断价值，结果显示在诊断脓毒性休克的过程中，RDW的AUC小于SOFA评分，但RDW的敏感度大于SOFA评分，RDW联合SOFA评分的敏感度(0.968)大于单纯SOFA评分或RDW。与彭菲等[28]研究结果中RDW预测脓毒性休克的敏感度(0.867)接近。本研究还显示RDW诊断重度器官功能障碍的AUC、敏感度及特异度均小于APACHE Ⅱ评分，但RDW联合APACHE Ⅱ评分的敏感度大于APACHE Ⅱ评分或RDW。表明RDW对老年脓毒症患者的严重程度评估及临床治疗具有指导作用，由于该指标的检测价格低廉，简单易得，可最大限度地提高对老年脓毒症危重患者的早期识别及救治能力。
综上所述，RDW与脓毒症严重程度相关，RDW升高是脓毒性休克及重度器官功能障碍的独立危险因素，RDW>20%者发生脓毒性休克及重度器官功能障碍的风险明显增加。RDW联合SOFA评分、APACHE Ⅱ评分评估脓毒症严重程度具有更高的敏感度，能够更好地指导临床对脓毒症危重患者的早期识别及干预。
基金
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  • 国家自然科学基金青年科学基金(81701890)
  • 全军保健专项课题(17BJZ17)
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参考文献 引证文献
排序方式：
[1]
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for Sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 762-774.
[2]
Bazick HS, Chang D, Mahadevappa K, et al. Red cell distribution width and all-cause mortality in critically ill patients[J]. Crit Care Med, 2011, 39(8): 1913-1921.
[3]
Ku NS, Kim HW, Oh HJ, et al. Red blood cell distribution width is an independent predictor of mortality in patients with gram-negative bacteremia[J]. Shock, 2012, 38(2): 123-127.
[4]
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Intensive Care Med, 2017, 43(3): 304-377.
[5]
Wu QH, Xiao ZY, Pu YN, et al. TnI and IL-18 levels are associated with prognosis of Sepsis[J]. Postgrad Med J, 2019, 95(1123): 240-244.
[6]
Chen QG, Zhang LS, Ge SH, et al. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study[J]. PeerJ, 2019, 7: e7083.
[7]
Letendre JA, Goggs R. Determining prognosis in canine sepsis by bedside measurement of cell-free DNA and nucleosomes[J]. J Vet Emerg Crit Care (San Antonio), 2018, 28(6): 503-511.
[8]
Liu JQ, Shi K, Chen MH, et al. Elevated miR-155 expression induces immunosuppression via CD39(+) regulatory T-cells in sepsis patient[J]. Int J Infect Dis, 2015, 40: 135-141.
[9]
Wilhelm J, Hettwer S, Hammer D, et al. Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department[J]. Med Klin Intensivmed Notfmed, 2012, 107(7): 558-563.
[10]
Viswanath D, Hegde R, Murthy V, et al. Red cell distribution width in the diagnosis of iron deficiency anemia[J]. Indian J Pediatr, 2001, 68(12): 1117-1119.
[11]
Zhang FX, Li ZL, Zhang ZD, et al. Prognostic value of red blood cell distribution width for severe acute pancreatitis[J]. World J Gastroenterol, 2019, 25(32): 4739-4748.
[12]
Montagnana M, Danese E. Red cell distribution width and cancer[J]. Ann Transl Med, 2016, 4(20): 399.
[13]
Zhang T, Li J, Lin Y, et al. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis[J]. Arch Med Res, 2017, 48(4): 378-385.
[14]
Sangoi MB, Guarda Ndos S, Rödel AP, et al. Prognostic value of red blood cell distribution width in prediction of in-hospital mortality in patients with acute myocardial infarction[J]. Clin Lab, 2014, 60(8): 1351-1356.
[15]
Seyhan EC, Özgül MA, Tutar N, et al. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease[J]. COPD, 2013, 10(4): 416-424.
[16]
Li XH, Liu Y, Lv YC. Relation between levels of blood lactic acid, blood lactic acid clearance rate and red blood cell distribution width in sepsis patients and prognosis[J]. Chin J Mod Med, 2020, 30(12): 22-26.
[李兴华, 刘颖, 吕艳超. 脓毒血症患者乳酸清除率、红细胞分布宽度和血乳酸水平及与预后的关系[J]. 中国现代医学杂志, 2020, 30(12): 22-26.]
[17]
Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock[J]. Am J Emerg Med, 2013, 31(3): 545-548.
[18]
Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients[J]. PLoS One, 2014, 9(8): e105436.
[19]
Vayá A, Sarnago A, Fuster O, et al. Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population[J]. Clin Hemorheol Microcirc, 2015, 59(4): 379-385.
[20]
Reinhart K, Bauer M, Riedemann NC, et al. New approaches to sepsis: molecular diagnostics and biomarkers[J]. Clin Microbiol Rev, 2012, 25(4): 609-634.
[21]
Yuan T, Cong Y, Meng J, et al. Arachidonic acid causes hidden blood loss-like red blood cell damage through oxidative stress reactions[J]. J Surg Res, 2017, 211: 14-20.
[22]
Subramani K, Raju SP, Chu XG, et al. Effect of plasma-derived extracellular vesicles on erythrocyte deformability in polymicrobial sepsis[J]. Int Immunopharmacol, 2018, 65: 244-247.
[23]
Souza AC, Volpini RA, Shimizu MH, et al. Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase[J]. Am J Physiol Renal Physiol, 2012, 302(8): F1045-F1054.
[24]
Mahmood NA, Mathew J, Kang B, et al. Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis[J]. Int J Crit Illn Inj Sci, 2014, 4(4): 278-282.
[25]
Tan C, Li M, Wang SY. Value of red cell distribution width in evaluating prognosis of patients with sepsis[J]. Jiangsu Med J, 2016, 42(16): 1788-1791.
[谈晨, 李梅, 王胜云. 红细胞分布宽度对脓毒症患者预后评估的价值[J]. 江苏医药, 2016, 42(16): 1788-1791.]
[26]
Zhao JJ, Chai YF, Zhang XK. The predictive value of red blood cell distribution width in the prognosis of patients with septic shock[J]. J Tianjin Med Univ, 2015, 21(2): 168-170.
[赵静静, 柴艳芬, 张晓堃. 红细胞分布宽度对脓毒症休克患者预后的预测价值[J]. 天津医科大学学报, 2015, 21(2): 168-170.]
[27]
Wang AY, Ma HP, Kao WF, et al. Red blood cell distribution width is associated with mortality in elderly patients with sepsis[J]. Am J Emerg Med, 2018, 36(6): 949-953.
[28]
Peng F, Jian J, Zhang HL, et al. The value of PDW, RDW, MCV in severity and prognosis evaluation of sepsis[J]. J Pract Shock, 2018, 2(5): 279-284.
[彭菲, 简娟, 张宏亮, 等. PDW、RDW和MCV在评估脓毒症严重程度及预后中的价值[J]. 实用休克杂志, 2018, 2(5): 279-284.]
2021年第46卷第5期
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doi: 10.11855/j.issn.0577-7402.2021.05.08
  • 接收时间：2020-11-17
  • 首发时间：2025-12-24
  • 出版时间：2021-05-28
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出版历史
  • 收稿日期：2020-11-17
  • 修回日期：2021-04-14
基金
National Natural Science Foundation of China(81701890)
国家自然科学基金青年科学基金(81701890)
Special Topic of PLA Health Care(17BJZ17)
全军保健专项课题(17BJZ17)
作者信息
    解放军东部战区总医院干部病房一科，南京 210002

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刘瑜，E-mail：
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https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2021.05.08
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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