Correlation between the dynamic variability of red blood cell distribution width and the readmission risk of patients with acute exacerbation of chronic obstructive pulmonary disease

doi:10.3877/cma.j.issn.1674-6902.2025.03.008

Abstract

Abstract:

Objective

To analyze the correlation between dynamic variability in red blood cell distribution width （RDW） and the risk of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.

Methods

A total of 96 AECOPD patients admitted to our hospital from January 2021 to December 2023 were enrolled and divided into three groups based on dynamic RDW changes on day 1 and day 4 of admission：normal group （30 cases），decreased group （32 cases），and elevated group（34 cases）. Clinical parameters，including comorbidities and white blood cell （WBC） levels，were collected.Logistic regression was used to analyze risk factors for 30 day readmission after discharge，and receiver operating characteristic curve（ROC） were employed to predict prognosis.

Results

Compared to the normal and decreased groups，the elevated group had 12 cases （35.29%） of 30 day readmission，higher WBC levels（8.26±1.95 ）×10⁹/L，higher C-reactive protein （CRP） levels （30.76±6.31 ）mg/L，and lower hemoglobin（Hb） levels （116.18±21.47 ） g/L （P＜0.05）. Univariate logistic regression analysis revealed that pH＜7.35（OR=4.364，95% CI：1.435～13.269），WBC （OR=1.456，95% CI：1.020～2.077），CRP（OR=1.139，95% CI：1.006～1.291），and dynamic RDW elevation （OR=10.263，95% CI：2.081 ～50.619） were significant predictors of 30 day readmission （P＜0.05）. Multivariate logistic regression analysis identified pH＜7.35 （OR=9.610，95% CI：1.799～51.340），CRP（OR=1.249，95% CI：1.050 ～1.486），and dynamic RDW elevation（OR=27.417，95% CI：3.385～222.054） as independent risk factors for 30-day readmission （P＜0.05）. ROC curve analysis showed that pH ＜7.35，CRP levels，and dynamic RDW changes had areas under the curve（AUC） of 0.639（0.489 ～0.790），0.597（0.431 ～0.763），and 0.733（0.609 ～0.857），with sensitivities of 42.10%，31. 60%，and 68. 40%，and specificities of 85. 70%，96. 10%，and 74. 00%，respectively.

Conclusion

Dynamic elevation of RDW，pH＜7.35，and CRP levels are risk factors for 30 day readmission in AECOPD patients. Monitoring dynamic RDW changes can help predict readmission risk，identify high-risk populations early，and guide personalized interventions to reduce short-term readmission rates and improve prognosis.

Key words: Chronic obstructive pulmonary disease, Chronic inflammation, Recurrence, C-reactive protein, Red blood cell distribution width

Hui Cheng, Zhendong Qian, Zhengbin Wu, Jingjing Wang, Wei Zhou, Shengquan Zou, Lei Zhang, Tianzhi Zhu. Correlation between the dynamic variability of red blood cell distribution width and the readmission risk of patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(03): 385-389.

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References 30

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临床资料	正常组 (n=30)	降低组 (n=32)	升高组 (n=34)	统计值	P 值
吸烟史	16(53.33)	17(53.13)	20(58.82)	0.279	0.870
糖尿病	7(23.33)	5(15.63)	3(8.83)	2.545	0.280
高血压	10(33.33)	9(28.13)	7(20.59)	1.337	0.512
支气管壁增厚	18(60.00)	21(65.63)	23(67.65)	0.430	0.807
肺气肿	21(70.00)	24(75.00)	26(76.47)	0.346	0.841
斑片状磨玻璃影	11(36.67)	13(40.63)	16(47.06)	0.730	0.694
出院后 30 d 再入院 [n(%)]	3(10.00)	5(15.63)	12(35.29)	6.792	0.031
PaCO₂>45 mmHg [n(%)]	17(56.67)	15(46.88)	18(52.94)	0.610	0.737
PaO₂<80 mmHg [n(%)]	21(70.00)	19(59.38)	22(64.71)	0.765	0.682
pH<7.35 [n(%)]	7(23.33)	6(18.75)	6(17.65)	0.357	0.836
WBC [×10⁹/L, (x̄ ± s)]	8.20±2.25	6.98±1.14	8.26±1.95	4.982	0.009
Hb [g/L, (x̄ ± s)]	131.03±19.05	125.34±22.17	116.18±21.47	4.106	0.020
PLT [×10⁹/L, (x̄ ± s)]	205.32±39.26	190.25±45.27	213.45±47.22	2.091	0.129
CRP [mg/L, (x̄ ± s)]	26.76±6.33	16.25±3.02	30.76±6.31	75.709	0.000

临床资料	正常组 (n=30)	降低组 (n=32)	升高组 (n=34)	统计值	P 值
吸烟史	16(53.33)	17(53.13)	20(58.82)	0.279	0.870
糖尿病	7(23.33)	5(15.63)	3(8.83)	2.545	0.280
高血压	10(33.33)	9(28.13)	7(20.59)	1.337	0.512
支气管壁增厚	18(60.00)	21(65.63)	23(67.65)	0.430	0.807
肺气肿	21(70.00)	24(75.00)	26(76.47)	0.346	0.841
斑片状磨玻璃影	11(36.67)	13(40.63)	16(47.06)	0.730	0.694
出院后 30 d 再入院 [n(%)]	3(10.00)	5(15.63)	12(35.29)	6.792	0.031
PaCO₂>45 mmHg [n(%)]	17(56.67)	15(46.88)	18(52.94)	0.610	0.737
PaO₂<80 mmHg [n(%)]	21(70.00)	19(59.38)	22(64.71)	0.765	0.682
pH<7.35 [n(%)]	7(23.33)	6(18.75)	6(17.65)	0.357	0.836
WBC [×10⁹/L, (x̄ ± s)]	8.20±2.25	6.98±1.14	8.26±1.95	4.982	0.009
Hb [g/L, (x̄ ± s)]	131.03±19.05	125.34±22.17	116.18±21.47	4.106	0.020
PLT [×10⁹/L, (x̄ ± s)]	205.32±39.26	190.25±45.27	213.45±47.22	2.091	0.129
CRP [mg/L, (x̄ ± s)]	26.76±6.33	16.25±3.02	30.76±6.31	75.709	0.000

影响因素	单因素分析		多因素分析
影响因素	P 值	OR (95%CI)	P 值	OR (95%CI)
性别	0.358	1.692 (0.552~5.187)
年龄	0.088	1.054 (0.992~1.119)	0.053	1.088 (0.999~1.185)
吸烟情况	0.321	2.000 (0.509~7.865)
糖尿病	0.982	1.016 (0.256~4.030)
高血压	0.933	0.952 (0.305~2.971)
支气管壁增厚	0.941	1.960 (1.326~2.823)
肺气肿	0.117	2.500 (0.794~7.870)
斑片状磨玻璃影	0.114	1.008 (0.998~1.018)
PaCO₂>45 mmHg	0.334	0.606 (0.220~1.673)
PaO₂<80 mmHg	0.885	0.926 (0.326~2.627)
pH<7.35	0.009	4.364 (1.435~13.269)	0.008	9.610 (1.799~51.340)
WBC	0.038	1.456 (1.020~2.077)	0.090	1.476 (0.942~2.314)
Hb	0.151	0.980 (0.954~1.007)
PLT	0.730	1.002 (0.991~1.013)
CRP	0.040	1.139 (1.006~1.291)	0.012	1.249 (1.050~1.486)
RDW 动态变化	0.003	-	0.001	-
RDW 动态降低	0.400	2.143 (0.364~12.628)	0.895	1.146 (0.151~8.691)
RDW 动态升高	0.004	10.263 (2.081~50.619)	0.002	27.417 (3.385~222.054)

影响因素	单因素分析		多因素分析
影响因素	P 值	OR (95%CI)	P 值	OR (95%CI)
性别	0.358	1.692 (0.552~5.187)
年龄	0.088	1.054 (0.992~1.119)	0.053	1.088 (0.999~1.185)
吸烟情况	0.321	2.000 (0.509~7.865)
糖尿病	0.982	1.016 (0.256~4.030)
高血压	0.933	0.952 (0.305~2.971)
支气管壁增厚	0.941	1.960 (1.326~2.823)
肺气肿	0.117	2.500 (0.794~7.870)
斑片状磨玻璃影	0.114	1.008 (0.998~1.018)
PaCO₂>45 mmHg	0.334	0.606 (0.220~1.673)
PaO₂<80 mmHg	0.885	0.926 (0.326~2.627)
pH<7.35	0.009	4.364 (1.435~13.269)	0.008	9.610 (1.799~51.340)
WBC	0.038	1.456 (1.020~2.077)	0.090	1.476 (0.942~2.314)
Hb	0.151	0.980 (0.954~1.007)
PLT	0.730	1.002 (0.991~1.013)
CRP	0.040	1.139 (1.006~1.291)	0.012	1.249 (1.050~1.486)
RDW 动态变化	0.003	-	0.001	-
RDW 动态降低	0.400	2.143 (0.364~12.628)	0.895	1.146 (0.151~8.691)
RDW 动态升高	0.004	10.263 (2.081~50.619)	0.002	27.417 (3.385~222.054)

指标	AUC	95%CI	P 值	敏感度 (%)	特异度 (%)	约登指数
pH<7.35	0.639	0.489~0.790	0.061	42.10	85.70	0.278
CRP 水平	0.597	0.431~0.763	0.193	31.60	96.10	0.277
RDW 动态变化	0.733	0.609~0.857	0.002	68.40	74.00	0.424

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