目的 探讨血红蛋白与红细胞分布宽度比值(HRR)预测急诊内科成年患者住院风险的价值.方法 收集2022年5-9月该院急诊内科门诊患者的临床资料;采用单因素、多因素二元logistic回归分析识别患者住院风险危险因素;绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC);然后绘制HRR与住院风险的限制性立方样条(RCS)图,分析HRR与住院风险的关系;最后根据HRR最佳截断值将患者分为低HRR组和高HRR组,基于HRR分组进行倾向匹配分析(PSM),并利用x2检验比较匹配后两组住院率.结果 本研究共纳入2 320例患者,住院791例,住院率为34.1％;多因素二元logistic回归分析提示HRR是急诊内科成年患者住院的独立影响因素(OR=0.68,95％CI:0.59～0.78,P＜0.01),当HRR取最佳截断值9.43时,AUC为0.65;RCS图提示当HRR≤10.39时,HRR水平越低患者住院风险越高,两者基本呈线性负相关;经PSM后,低HRR组住院率明显高于高HRR组(P＜0.01).结论 HRR可以用于预测急诊内科成年患者的住院风险,HRR越低,住院风险越高;HRR可能作为临床工作中评估患者病情严重程度的标志物.
Objective To explore the value of the ratio of hemoglobin to red blood cell distribution width(HRR)in predicting the hospitalization risk of the patients in emergency internal medicine outpatient.Methods The clinical data of the patients in the emergency internal medicine outpatient of this hospital from May to September 2022 were collected;the univariate and multivariate binary logistic regression analysis was used to identify the risk factors for the patients hospitalization.The receive operating characteristics(ROC)curve was drawn,and the area under the curve(AUC)was calculated.Then the restrictive cubic spline(RCS)chart of HRR and the hospitalization risk was drawn and the relationship between HRR and the hospitaliza-tion risk was analyzed.Finally,the patients were divided into the low HRR group and the high HRR group ac-cording to the optimal cut-off value of HRR,the propensity score matching(PSM)was performed based on HRR grouping,and the hospitalization rates after matching were compared between the two groups by using x2 test.Results A total of 2 320 patients were included in this study,in which 791 cases were hospitalized,with an hospitalization rate of 34.1％;the multivariate logistic regression analysis suggested that HRR was an independent influence factor for hospitalization of the patients in the emergency internal medicine department(OR=0.68,95％CI:0.59-0.78,P＜0.05);when the optimal cutoff value of HRR was 9.43,AUC was 0.65;the RCS chart indicated that when HRR≤10.39,the lower the HRR level,the higher the hospitaliza-tion risk for the patients,and the two basically showed the linearly negative correlation.After PSM,the hospi-talization rate in the low HRR group was significantly higher than that in the high HRR group(P＜0.01).Conclusion HRR could be used to predict the hospitalization risk of adult patients in emergency internal med-icine department.The lower the HRR,the higher the hospitalization risk;HRR may be used as a marker to as-sess the disease severity in clinical work.
周浩;许珊;秦开秀
重庆医科大学附属第二医院急诊内科,重庆 400010
临床医学
血红蛋白与红细胞分布宽度之比;住院风险;预测价值;急诊科
ratio of hemoglobin to red blood cell distribution width;hospitalization risk;predictive val-ue;emergency department
《重庆医学》 2024 (013)
1959-1965,1971 / 8
重庆市科卫联合医学科研项目(2021MSXM162).
10.3969/j.issn.1671-8348.2024.13.007
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