红细胞分布宽度红细胞压积水平与老年上消化道出血患者qSOFA评分的关系及对预后的评估价值研究

doi:10.3969/j.issn.1006-6233.2025.09.028

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摘要 目的: 观察老年上消化道出血(UGB)患者红细胞分布宽度(RDW)、红细胞压积(Hct)水平变化,分析其与快速序贯器官衰竭(qSOFA)评分的关系及对患者预后的预测价值。方法: 纳入2021年12月至2024年5月本院收治的老年UGB患者104例,测定患者血液RDW、Hct水平,观察两种指标水平变化与患者qSOFA评分及预后的关联性。结果: 老年UGB预后不良患者RDW水平、qSOFA评分、年龄及出血量≥1000mL占比高于预后良好患者,Hct低于预后良好患者,差异均有统计学意义(P<0.05)。Logistic回归分析显示:RDW、qSOFA评分及出血量≥1000mL是影响老年UGB患者预后不良的危险因素,Hct是影响老年UGB患者预后不良的保护因素,关联性均有统计学意义(P<0.05)。Spearman相关性分析显示:老年UGB患者RDW水平与qSOFA评分成正相关,Hct与qSOFA评分成负相关,相关性均有统计学意义(r=0.207、-0.197,P<0.05)。ROC曲线,结果显示RDW、Hct评估老年UGB患者预后不良的AUC分别为0.731、0.777,而RDW+Hct两项联合评估老年UGB患者预后不良的AUC为0.845,均高于RDW和Hct的AUC,差异有统计学意义(P<0.05),最大约登指数下的敏感度和特异度分别为0.724、0.827。结论: 老年UGB患者RDW升高、Hct降低与患者qSOFA评分及预后情况相关,且RDW、Hct水平对患者预后不良具有一定的评估价值。

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关键词 ：上消化道出血, 红细胞分布宽度, 红细胞压积, 快速序贯器官衰竭评分

Abstract：Objective: To observe the changes of red blood cell distribution width (RDW) and hematocrit (Hct) in elderly patients with upper gastrointestinal bleeding (UGB), and to analyze the relationship with quick sequential organ failure assessment (qSOFA) score and the predictive value on prognosis of patients. Methods: Totally 104 elderly patients with UGB in the hospital from December 2021 to May 2024 were included. The levels of RDW and Hct in the blood of patients were measured, and the association between changes of the two indexes and qSOFA score and prognosis of patients was observed. Results: The RDW level, qSOFA score, age and proportion of bleeding volume≥1000 mL in elderly UGB patients with poor prognosis were higher than those in patients with good prognosis while the Hct was lower than that in patients with good prognosis, with statistical differences (P<0.05). Logistic regression analysis showed that RDW, qSOFA score and blood loss volume≥1000 mL are the risk factors affecting the poor prognosis of elderly UGB patients, and Hct was a protective factor, and the associations were statistically significant (P<0.05). Spearman correlation analysis indicated that RDW level in elderly UGB patients was positively correlated with qSOFA score, and Hct was negatively correlated with qSOFA score, with statistical correlations (r=0.207, -0.197, P<0.05). ROC curve demonstrated that the AUCs of RDW and Hct in evaluating the poor prognosis of elderly UGB patients were 0.731 and 0.777, respectively, while the AUC of RDW+Hct in assessing the poor prognosis was 0.845, higher than AUC of RDW and Hct, and the difference was statistically significant (P<0.05). The sensitivity and specificity under the maximum Youden index were 0.724 and 0.827, respectively. Conclusion: The increase of RDW and decrease of Hct in elderly UGB patients are related to the qSOFA score and prognosis of patients, and the levels of RDW and Hct have certain evaluated value on the poor prognosis of patients.

Key words： Upper gastrointestinal bleeding Red blood cell distribution width Hematocrit Quick sequential organ failure assessment score

基金资助:安徽省卫生健康科研项目(2023年度),(编号:AHWJ2023A30052)

通讯作者: 杨晓红

引用本文:

王秋月, 谢发平, 周仁正, 吴晌犊, 朱雪梅. 红细胞分布宽度红细胞压积水平与老年上消化道出血患者qSOFA评分的关系及对预后的评估价值研究[J]. 河北医学, 2025, 31(9): 1568-1573.
WANG Qiuyue, XIE Faping, ZHOU Renzheng, et al. Relationship of Red Blood Cell Distribution Width and Hematocrit Level with qSOFA Score in Elderly Patients with Upper Gastrointestinal Bleeding and Evaluation Value on Prognosis. HeBei Med, 2025, 31(9): 1568-1573.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.09.028 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I9/1568

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