RDW/PLT联合LODS评分预测脓毒症并发肺炎预后的临床意义

doi:10.3877/cma.j.issn.1674-6902.2026.01.014

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 89 -94. doi: 10.3877/cma.j.issn.1674-6902.2026.01.014

论著

RDW/PLT联合LODS评分预测脓毒症并发肺炎预后的临床意义

陈林欣¹^,², 沈利汉¹^,²^,^†(

), 邱敏珊², 卢瑞瑜², 赖燕波², 杜瑞冬², 卢敏贞³, 王洁³

¹518034　深圳，南方医科大学深圳临床医学院
²523000　东莞，南方医科大学第十附属医院·东莞市人民医院重症医学科
³523000　东莞，南方医科大学第十附属医院·东莞市人民医院呼吸内科

收稿日期:2025-09-23 出版日期:2026-02-25
通信作者: 沈利汉
基金资助:
东莞市社会发展科技重点项目(20221800906292；20231800938312)

Clinical significance of red blood cell volume distribution width/platelet combined with Logistic organ dysfunction score in predicting the prognosis of sepsis complicated with pneumonia

linxin Chen¹^,², Lihan Shen¹^,²^,^†(), minshan Qiu², ruiyu Lu², yanbo Lai², Ruidong Du², minzhen Lu³, Jie Wang³

¹Shenzhen School of Clinical Medicine, Southern Medical University, Shenzhen 518034, China
²Intensive Care Unit, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People′s Hospital), Dongguan 523000, China
³Respiratory Medicine Department, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People′s Hospital), Dongguan 523000, China

Received:2025-09-23 Published:2026-02-25
Corresponding author: Lihan Shen

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引用本文：

陈林欣, 沈利汉, 邱敏珊, 卢瑞瑜, 赖燕波, 杜瑞冬, 卢敏贞, 王洁. RDW/PLT联合LODS评分预测脓毒症并发肺炎预后的临床意义[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 89-94.

linxin Chen, Lihan Shen, minshan Qiu, ruiyu Lu, yanbo Lai, Ruidong Du, minzhen Lu, Jie Wang. Clinical significance of red blood cell volume distribution width/platelet combined with Logistic organ dysfunction score in predicting the prognosis of sepsis complicated with pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 89-94.

目的

分析红细胞体积分布宽度/血小板比值(red blood cell volume distribution width/platelet, RDW/PLT)联合Logistic器官功能障碍评分(Logistic organ dysfunction score, LODS)预测脓毒症并发肺炎患者预后的临床意义。

方法

选取2018年1月至2024年12月我院收治的脓毒症并发肺炎患者153例为对象，根据住院期间预后情况分组，存活者99例为对照组，死亡者54例为观察组。收集患者临床资料，比较两组机械通气、急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)评分、LODS评分、RDW、第1天、第3天、第5天、第7天(D1 RDW/PLT、D3 RDW/PLT、D5 RDW/PLT、D7 RDW/PLT)，采用二元Logistic回归分析预后影响因素，受试者特征工作(receiver operating characteristic, ROC)曲线分析LODS评分、RDW/PLT对脓毒症并发肺炎严重程度的预测。

结果

Logistic回归分析显示，有创机械通气(OR＝11.095，95%CI：1.923~12.816)、APACHE Ⅱ评分(OR＝0.916，95%CI：0.840~0.999)、高D7 RDW(OR＝1.448，95%CI：1.149~1.825)、高D7 RDW/PLT(OR＝8.020，95%CI：1.077~59.744)、高LODS评分(OR＝1.293，95%CI：1.091~1.531)为脓毒症并发肺炎死亡的危险因素(P<0.05)。ROC曲线分析显示，有创机械通气、APACHE Ⅱ评分、D7 RDW、D7 RDW/PLT和LODS评分的曲线下面积(area under the curve, AUC)值分别为0.628、0.606、0.727、0.830、0.719。D7 RDW/PLT最佳截断值为0.135，灵敏度为79.6%，特异度为74.7%。LODS评分最佳截断值为9.5分，灵敏度55.6%，特异度80.8%。联合预测AUC为0.872，灵敏度83.3%，特异度77.8% (P<0.01)。

结论

RDW/PLT联合LODS评分预测脓毒症并发肺炎患者具有临床意义。

关键词: 脓毒症, 肺炎, Logistic器官功能障碍评分, 红细胞体积分布宽度与血小板比值

Objective

To analyze the correlation between the red blood cell volume distribution width/platelet ratio (RDW/PLT) combined with the Logistic organ dysfunction score (LODS) and disease severity in patients with sepsis complicated by pneumonia.

Methods

A total of 153 patients with sepsis complicated by pneumonia admitted to our hospital from January 2018 to December 2024 were enrolled. They were divided into groups according to prognosis during hospitalization: 99 survivors served as the control group, and 54 non-survivors as the observation group. Clinical data were collected, and comparisons were made between the two groups regarding mechanical ventilation, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, LODS score, RDW, and RDW/PLT on day 1, day 3, day 5, and day 7 (D1 RDW/PLT, D3 RDW/PLT, D5 RDW/PLT, D7 RDW/PLT). Binary logistic regression was used to analyze factors influencing prognosis, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of LODS score and RDW/PLT for disease severity in sepsis with pneumonia.

Results

Logistic regression analysis showed that invasive mechanical ventilation (OR=11.095, 95%CI: 1.923~12.816), APACHE Ⅱ score (OR=0.916, 95%CI: 0.840~0.999), high D7 RDW (OR=1.448, 95%CI: 1.149~1.825), high D7 RDW/PLT (OR=8.020, 95%CI: 1.077~59.744), and high LODS score (OR=1.293, 95%CI: 1.091~1.531) were risk factors for death in patients with sepsis complicated by pneumonia (P<0.05). ROC curve analysis showed that the area under the curve (AUC) values for invasive mechanical ventilation, APACHE Ⅱ score, D7 RDW, D7 RDW/PLT, and LODS score were 0.628, 0.606, 0.727, 0.830, and 0.719, respectively. The optimal cutoff value for D7 RDW/PLT was 0.135, with a sensitivity of 79.6% and specificity of 74.7%. The optimal cutoff value for LODS score was 9.5 points, with a sensitivity of 55.6% and specificity of 80.8%. The combined prediction had an AUC of 0.872, with a sensitivity of 83.3% and specificity of 77.8% (P<0.01).

Conclusion

The combination of RDW/PLT and LODS score has clinical significance in predicting disease severity in patients with sepsis complicated by pneumonia.

Key words: Sepsis, Pneumonia, Logistic organ dysfunction score, Red blood cell volume distribution width and platelet ratio

表1 两组脓毒症并发肺炎患者临床资料结果比较

临床资料	观察组(n＝54)	对照组(n＝99)	χ²/t/Z值	P值
性别[n(%)]			0.782	0.376
男	35(64.81)	71(71.72)
女	19(35.19)	28(28.28)
糖尿病[n(%)]	13(24.07)	17(17.17)	1.056	0.304
LODS[分，M(Q₁，Q₃)]	10(6，12)	6(4，9)	4.489	0.000
高血压[n(%)]	22(40.74)	37(37.37)	0.167	0.683
有创机械通气[n(%)]	52(96.30)	70(70.71)	14.162	0.000
SOFA[分，M(Q₁，Q₃)]	15(8，19)	11(8，15)	2.794	0.005
APACHE Ⅱ[分，(±s)]	23.43±6.87	20.88±6.88	2.189	0.030
CRRT[n(%)]	35(64.81)	32(32.32)	14.986	0.000

表1 两组脓毒症并发肺炎患者临床资料结果比较

临床资料	观察组(n＝54)	对照组(n＝99)	χ²/t/Z值	P值
性别[n(%)]			0.782	0.376
男	35(64.81)	71(71.72)
女	19(35.19)	28(28.28)
糖尿病[n(%)]	13(24.07)	17(17.17)	1.056	0.304
LODS[分，M(Q₁，Q₃)]	10(6，12)	6(4，9)	4.489	0.000
高血压[n(%)]	22(40.74)	37(37.37)	0.167	0.683
有创机械通气[n(%)]	52(96.30)	70(70.71)	14.162	0.000
SOFA[分，M(Q₁，Q₃)]	15(8，19)	11(8，15)	2.794	0.005
APACHE Ⅱ[分，(±s)]	23.43±6.87	20.88±6.88	2.189	0.030
CRRT[n(%)]	35(64.81)	32(32.32)	14.986	0.000

表2 两组脓毒症并发肺炎患者实验室指标比较[M(Q₂₅，Q₇₅)]

实验室指标	观察组(n＝54)	对照组(n＝99)	χ²/t/Z值	P值
血红蛋白(g/L)	90.00(76.50，113.25)	93.00(81.00，120.00)	1.487	0.137
血小板(×10⁹/L)	146.0(74.8，212.3)	145.0(111.0，218.0)	1.080	0.280
D1RDW(%)	15.20(13.80，16.75)	14.40(13.40，16.00)	2.265	0.024
D3RDW(%)	15.6(14.2，17.3)	14.6(13.6，16.1)	2.774	0.006
D5RDW(%)	15.55(14.70，17.88)	14.80(13.70，15.90)	3.655	0.000
D7RDW(%)	15.90(15.08，17.88)	14.60(13.60，15.80)	4.630	0.000
pH	7.35(7.21，7.45)	7.39(7.32，7.44)	1.385	0.166
D二聚体(μg/ml)	4.44(2.42, 9.32)	5.20(2.27，11.90)	0.560	0.576
肌酐(μmol/L)	308.00(116.20，558.50)	170.80(86.00，336.50)	2.388	0.017
白蛋白[g/L，(±s)]	27.55±6.02	28.67±5.687	1.140	0.256
ICU住院时间(d)	15.0(10.0，25.5)	12.0(8.0，22.0)	1.797	0.072
D1 RDW/PLT	0.104(0.075，0.210)	0.095(0.062，0.138)	1.527	0.127
D3 RDW/PLT	0.209(0.114，0.483)	0.129(0.076，0.231)	3.134	0.002
D5 RDW/PLT	0.339(0.154，0.747)	0.113(0.073，0.214)	5.198	0.000
D7 RDW/PLT	0.327(0.144，0.617)	0.085(0.057，0.136)	6.738	0.000

表2 两组脓毒症并发肺炎患者实验室指标比较[M(Q₂₅，Q₇₅)]

实验室指标	观察组(n＝54)	对照组(n＝99)	χ²/t/Z值	P值
血红蛋白(g/L)	90.00(76.50，113.25)	93.00(81.00，120.00)	1.487	0.137
血小板(×10⁹/L)	146.0(74.8，212.3)	145.0(111.0，218.0)	1.080	0.280
D1RDW(%)	15.20(13.80，16.75)	14.40(13.40，16.00)	2.265	0.024
D3RDW(%)	15.6(14.2，17.3)	14.6(13.6，16.1)	2.774	0.006
D5RDW(%)	15.55(14.70，17.88)	14.80(13.70，15.90)	3.655	0.000
D7RDW(%)	15.90(15.08，17.88)	14.60(13.60，15.80)	4.630	0.000
pH	7.35(7.21，7.45)	7.39(7.32，7.44)	1.385	0.166
D二聚体(μg/ml)	4.44(2.42, 9.32)	5.20(2.27，11.90)	0.560	0.576
肌酐(μmol/L)	308.00(116.20，558.50)	170.80(86.00，336.50)	2.388	0.017
白蛋白[g/L，(±s)]	27.55±6.02	28.67±5.687	1.140	0.256
ICU住院时间(d)	15.0(10.0，25.5)	12.0(8.0，22.0)	1.797	0.072
D1 RDW/PLT	0.104(0.075，0.210)	0.095(0.062，0.138)	1.527	0.127
D3 RDW/PLT	0.209(0.114，0.483)	0.129(0.076，0.231)	3.134	0.002
D5 RDW/PLT	0.339(0.154，0.747)	0.113(0.073，0.214)	5.198	0.000
D7 RDW/PLT	0.327(0.144，0.617)	0.085(0.057，0.136)	6.738	0.000

图1 脓毒症并发肺炎患者典型CT影像图。图A为右肺下叶见大片实变，其内见支气管通气征；图B为双肺上叶、下叶背侧及左肺上叶下舌段部分实变、不张。双侧胸腔背侧见新月形液性低密度区；图C为双肺各叶散在斑点、小片、斑片灶，双肺下叶部分呈片状实变影；图D为左肺上叶前段、右肺上叶后段病变内空洞形成

表3 影响脓毒症并发肺炎患者预后的二元Logistic回归分析

影响因素	β值	标准误	Wald值	P值	OR值	95%CI
有创机械通气	2.407	0.894	7.244	0.007	11.095	1.923~12.816
APACHEⅡ评分	0.087	0.044	3.886	0.049	0.916	0.840~0.999
D7 RDW	0.370	0.118	9.855	0.002	1.448	1.149~1.825
D7 RDW/PLT	2.082	1.025	4.129	0.042	8.020	1.077~59.744
LODS评分	0.257	0.086	8.840	0.003	1.293	1.091~1.531

表3 影响脓毒症并发肺炎患者预后的二元Logistic回归分析

影响因素	β值	标准误	Wald值	P值	OR值	95%CI
有创机械通气	2.407	0.894	7.244	0.007	11.095	1.923~12.816
APACHEⅡ评分	0.087	0.044	3.886	0.049	0.916	0.840~0.999
D7 RDW	0.370	0.118	9.855	0.002	1.448	1.149~1.825
D7 RDW/PLT	2.082	1.025	4.129	0.042	8.020	1.077~59.744
LODS评分	0.257	0.086	8.840	0.003	1.293	1.091~1.531

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Clinical significance of red blood cell volume distribution width/platelet combined with Logistic organ dysfunction score in predicting the prognosis of sepsis complicated with pneumonia

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Clinical significance of red blood cell volume distribution width/platelet combined with Logistic organ dysfunction score in predicting the prognosis of sepsis complicated with pneumonia