The value of red cell volume distribution width in evaluating the clinical outcome of sepsis in the elderly

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 Ⅱ score, 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 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. DOI: 10.11855/j.issn.0577-7402.2021.05.08