Nghiên cứu sự biến đổi của độ phân bố hồng cầu và giá trị tiên lượng tử vong ở bệnh nhân sốc nhiễm khuẩn=Studying the variation of red cell distribution and prognostic value of mortality among septic shock patients

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Tác giả: Văn Mạnh Bùi, Tiến Tuyên Hoàng, Lan Phương Lê, Trung Kiên Nguyễn, Thái Dũng Phạm, Quốc Việt Trần, Anh Đức Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2024

Mô tả vật lý: tr.33-39

Bộ sưu tập: Báo, Tạp chí

ID: 244871

Thêm vào giỏ

Đánh sự biến đổi của độ phân bố hồng cầu (RDW) và giá trị tiên lượng tử vong ở bệnh nhân sốc nhiễm khuẩn. Đối tượng và phương pháp: Nghiên cứu tiến cứu mô tả theo dõi dọc 97 bệnh nhân tại Trung tâm Hồi sức tích cực, Bệnh viện TƯQĐ 108 từ tháng 4 năm 2023 đến tháng 1 năm 2024. Bệnh nhân ≥ 18 tuổi, chẩn đoán sốc nhiễm khuẩn theo tiêu chuẩn của SCCM/ESICM 2016. Đo lường chỉ số RDW tại thời điểm chẩn đoán sốc nhiễm khuẩn, ngày thứ 1, 3, 5, 7 sau khi chẩn đoán sốc nhiễm khuẩn. Đánh giá sự biến đổi của chỉ số RDW và giá trị tiên lượng tử vong so với thang điểm SOFA và APACHE II ở bệnh nhân sốc nhiễm khuẩn. Kết quả: Chỉ số RDW trung bình ở nhóm bệnh nhân tử vong cao hơn so với nhóm bệnh nhân sống sót (p<
0,01). Chỉ số RDW tại thời điểm T7 (AUC = 0,9, p<
0,001) với điểm cắt 17% có giá trị cao hơn hai thang điểm SOFA và APACHE II trong dự đoán tử vong với độ nhạy là 80% và độ đặc hiệu là 89,5%. RDW ở nhóm bệnh nhân tử vong cao hơn so với nhóm bệnh nhân sống sót trong các thời điểm từ T0 đến T7 (p<
0,01). Ở nhóm bệnh nhân tử vong chỉ số này tăng lên rõ rệt tại thời điểm T5 (16,8%) và thời điểm T7 (18,7%)
Ở nhóm bệnh nhân sống sót chỉ số RDW biến đổi ít tại các thời điểm nghiên cứu với giá trị trung bình dao động từ 14,4 ± 1,4% đến 15,1 ± 1,78% (p<
0,05). Kết luận: Chỉ số RDW tại các thời điểm nghiên cứu với điểm cắt 14,9-17% cũng như biến thiên tăng dần của chỉ số này có giá trị tốt để tiên lượng tử vong ở bệnh nhân sốc nhiễm khuẩn so sánh với thang điểm SOFA và APACHE II (p<
0,05).To assess the variation of red cell distribution width (RDW) in septic shock patients and its association with mortality prognosis in septic shock patients. Subject and method: A prospective longitudinal descriptive study, with 97 patients at the Intensive Care Unit of 108 Military Central Hospital from April 2023 to January 2024. Patients ≥ 18 years old, diagnosed with septic shock according to SCCM/ESICM 2016 criteria. RDW index measured at the time of septic shock diagnosis, on days 1, 3, 5, 7 after septic shock diagnosis. Assess the variation of RDW and prognostic value of RDW for mortality to compare with SOFA and APACHE II scores in septic shock patients. Result: The average RDW index in the deceased patient group was higher than in the surviving patient group (p<
0.01). RDW index at T7 (AUC = 0.9, p<
0.001) with a cutoff of 17% had a higher value than both SOFA and APACHE II scores in predicting mortality with a sensitivity of 80% and specificity of 89.5%. RDW in the deceased patient group was higher than in the surviving patient group from T0 to T7 (p<
0.01). In the deceased patient group, this index notably increased at T5 (16.8%) and T7 (18.7%). In the surviving patient group, RDW showed less variation during the study periods with average values ranging from 14.4 ± 1.4% to 15.1 ± 1.78% (p<
0.05). Conclusion: The RDW index at various study time points with cutoffs of 14.9-17%, as well as the gradually increasing variability of this index, have significant value in predicting mortality in patients with septic shock compared to the SOFA and APACHE II scores (p<
0.05).

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