Predictive value of red blood cell distribution width on in-hospital malignant arrhythmia event in patients with chronic heart failure

目的：探讨红细胞分布宽度（RDW）与慢性心力衰竭（CHF）患者住院期间发生恶性心律失常事件的关系及其预测价值。方法回顾性分析2014年1月至2016年2月北京大学第三医院急诊科和心血管内科收治的CHF住院患者的临床资料，入选标准为入院时美国纽约心脏病协会（NYHA）心功能分级为Ⅱ级或Ⅱ级以上、且病程≥6个月者。根据住院期间是否发生恶性心律失常（室性心动过速、心室扑动/心室纤颤）将患者分为两组。比较两组间RDW、左心室射血分数（LVEF）的差异；用Spearman秩相关法分析RDW、LVEF与恶性心律失常事件的相关性；用受试者工作特征曲线（ROC）分析RDW、LVEF对CHF患者发生恶性心律失常的预测价值。结果入选226例CHF患者，男性148例，女性78例；年龄26～91岁，平均（61.52±13.27）岁；住院时间14～21d，平均（17.5±3.5）d；102例患者（45.13%）住院期间发生了恶性心律失常。两组患者性别、年龄、既往史、心脏病病因、血管紧张素受体转化酶抑制剂/血管紧张素Ⅱ受体抑制剂（ACEI/ARB）和β受体阻滞剂使用率、血钾水平等差异均无统计学意义。与非恶性心律失常组比较，恶性心律失常组RDW明显增大〔（13.28±1.07）%比（12.87±1.32）%，t＝2.531，P＝0.012〕，LVEF明显降低（0.425±0.116比0.458±0.104， t＝2.249，P＝0.026），心功能Ⅱ级患者比例显著降低（4.90%比19.35%，χ2＝10.451，P＝0.000）、Ⅳ级患者比例显著升高（57.84%比41.13%，χ2＝6.264，P＝0.011）。恶性心律失常事件与RDW呈显著正相关（r＝0.758， P＝0.023），与LVEF呈显著负相关（r＝-0.719，P＝0.019）。RDW、LVEF评估CHF患者院内发生恶性心律失常风险的ROC曲线下面积（AUC）分别为0.882〔95%可信区间（95%CI）＝0.839～0.925〕、0.903（95%CI＝0.866～0.941）。RDW最佳截断值为14.20%时，预测院内发生恶性心律失常事件的敏感度为82.0%，特异度为79.0%；LVEF最佳截断值为0.375时，预测院内发生恶性心律失常事件的敏感度为78.0%，特异度为85.0%。结论 RDW可用于预测CHF患者住院期间恶性心律失常的发生。Objective To study the relationship between red blood cell distribution width (RDW) and the malignant arrhythmia event of patients with chronic heart failure (CHF) during hospitalization. Methods A retrospective study was conducted. The clinical data of patients with CHF admitted to Department of Emergency and Cardiology of Peking University Third Hospital from January 2014 to February 2016 were reviewed. The patients with New York Heart Association (NYHA) Class Ⅱ, Ⅲ, Ⅳ at hospital admission and courses lasted at least six months were enrolled. The patients were divided into two groups according to malignant arrhythmia events (ventricular tachycardia, ventricular flutter or ventricular fibrillation) during hospitalization, i.e. malignant arrhythmia group and non-malignant arrhythmia group. The value of RDW and left ventricular ejection fraction (LVEF) were compared between two groups, and correlation of RDW, LVEF and malignant arrhythmia events by Spearman rank correlation analysis were studied, and the predictive value of RDW and LVEF for malignant arrhythmia events in patients with CHF was analyzed with receiver operating characteristic (ROC) curve. Results A total of 226 CHF patients were enrolled with 148 male and 78 female, the average age was (61.52±13.27) years old (range: 26-91 years old), the average hospitalization days were (14.5±3.5) days (range: 14-21 days), and malignant arrhythmia occurred in 102 patients (45.13%) during hospitalization. There were no statistically differences in gender, age, past history, etiology of heart disease, the usage of angiotensin receptor converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor inhibitors (ARB) and beta blockers, serum potassium levels and so on between two groups. Compared with non-malignant arrhythmia group, the value of the RDW was significantly increased in malignant arrhythmia group [(13.28±1.07)% vs. (12.87±1.32)%, t = 2.531, P = 0.012], but the levels of LVEF was significantly reduced (0.425±0.116 vs. 0.458±0.104, t = 2.249, P = 0.026), the proportion of patients with NYHA Class Ⅱ was significantly lower (4.90% vs. 19.35%, χ2= 10.451, P = 0.000) and that of NYHA Class Ⅳ was just the opposite (57.84% vs. 41.13%, χ2 = 6.264, P = 0.011). The value of the RDW showed positively correlation with the malignant arrhythmia events (r = 0.758, P = 0.023), while LVEF was negatively correlated (r = -0.719, P = 0.019). The area under the ROC curve (AUC) for predicting the malignant arrhythmia events of RDW and LVEF was 0.882 [95% confidence interval (95%CI) = 0.839-0.925), 0.903 (95%CI = 0.866-0.941), respectively. The sensitivity and specificity for RDW in predicting in-hospital malignant arrhythmia event respectively were 82.0% and 79.0% with the optimal cut-off of 14.20%, and those for LVEF were 78.0% and 85.0% with the optimal cut-off of 0.375. Conclusion RDW can be used to predict the occurrence of malignant arrhythmia in patients with CHF during hospitalization.国家自然科学基金中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)121090-10942