cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2025-40-1-77-84cardiotomsk-2635Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESШирина распределения эритроцитов как новый прогностический фактор госпитальной летальности у пациентов с острым инфарктом миокардаRed cell distribution width as a novel prognosticator for in-hospital mortality in patients with acute myocardial infarctionhttps://orcid.org/0000-0002-2013-2647ХоангЧ. Х.HoangT. H.

Хоанг Чыонг Хюй, канд. мед. наук, преподаватель, кафедра внутренних болезней, Медицинский университет Фама Нгок Тача, Хошимин, Вьетнам; врач-кардиолог, кардиологическое отделение 5, Кардиологическая больница Там Дык, Хошимин,

72410, Хошимин, ул. Дуонг Куанг Трунг, 2,

756335, Хошимин, ул. Нгуен Лыонг Банг, 04

Truong H. Hoang, Cand. Sci. (Med.), PhD, Lecturer, Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Cardiologist at the Department of Cardiology 5, Tam Duc Heart Hospital, Ho Chi Minh City

02, Duong Quang Trung Str., Ho Chi Minh City, 72410,

04, Nguyen Luong Bang Str., Ho Chi Minh City, 756335

truonghh@pnt.du.vnhttps://orcid.org/0009-0002-2135-2606МайсковВ. В.MaiskovV. V.

Майсков Виктор Викторович, канд. мед. наук, доцент, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева, Медицинский институт РУДН; заведующий. отделением рентгенохирургических методов диагностики и лечения, ГКБ им. В.В. Виноградова ДЗМ

117198, Москва, ул. Миклухо-Маклая, 6,

117292, Москва, ул. Вавилова, 61

Viktor V. Maiskov, Cand. Sci. (Med.), Associate Professor, Department of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after V.S. Moiseev, Medical Institute of RUDN University, Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment, Vinogradov Municipal Clinical Hospital

6, Mikluho-Maklaya Str., Moscow, 117198, 

61, Vavilova Str., Moscow, 117292

maiskov-angio@yandex.ruhttps://orcid.org/0000-0001-6818-8845МерайИ. А.MeraiI. A.

Мерай Имад Ахмадович, канд. мед. наук, доцент, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева, Медицинский институт РУДН; заведующий I отделением реанимации и интенсивной терапии кардиологического профиля, ГКБ им. В.В. Виноградова ДЗМ

117198, Москва, ул. Миклухо-Маклая, 6,

117292, Москва, ул. Вавилова, 61

Imad A. Merai, Cand. Sci. (Med.), Associate Professor, Department of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after V.S. Moiseev, Medical Institute of RUDN University, Head of the I Department of Resuscitation and Intensive Care of Cardiological Profile, Vinogradov Municipal Clinical Hospital

6, Mikluho-Maklaya Str., Moscow, 117198, 

61, Vavilova Str., Moscow, 117292

imadmerai@yahoo.comhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZ. D.

Кобалава Жанна Давидовна, д-р мед. наук, чл.-кор. РАН, профессор, заведующий кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева, Медицинский институт РУДН

117292, Москва, ул. Вавилова, 61

Zhanna D. Kobalava, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after V.S. Moiseev, Medical Institute of RUDN University

61, Vavilova Str., Moscow, 117292

zkobalava@mail.ruМедицинский университет Фам Нгок Тхат; Кардиологическая больница Там ДыкВьетнамPham Ngoc Thach University of Medicine; Tam Duc Heart HospitalViet NamРоссийский университет дружбы народов имени Патриса Лумумбы (РУДН); Городская клиническая больница имени В.В. Виноградова Департамента здравоохранения Москвы (ГКБВин)РоссияPeoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University); Vinogradov Municipal Clinical HospitalRussian FederationГородская клиническая больница имени В.В. Виноградова Департамента здравоохранения Москвы (ГКБВин)РоссияVinogradov Municipal Clinical HospitalRussian Federation2025130420254017784Copyright © Хоанг Ч.Х., Майсков В.В., Мерай И.А., Кобалава Ж.Д., 20252025Хоанг Ч.Х., Майсков В.В., Мерай И.А., Кобалава Ж.Д.Hoang T.H., Maiskov V.V., Merai I.A., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2635Цель

Цель: исследовать ассоциацию между шириной распределения эритроцитов (Red cell Distribution Width, RDW) и госпитальной летальностью, разработать клиническую модель риска госпитальной летальности у пациентов с острым инфарктом миокарда (ОИМ).

Материал иметоды

Материал иметоды. Проспективное наблюдательное исследование включило 577 пациентов с ОИМ, которым проводили коронарографию (КАГ) в течение 24 ч с момента заболевания, и было разделено в соответствии с медианным значением RDW. Ассоциация между RDW, клиническими параметрами и госпитальной летальностью оценивалась с использованием логистической регрессии и анализа рабочей характеристики приемника (ROC-кривая). Прогностическая модель была разработана с использованием байесовского подхода и логистического анализа с выявлением предикторов смертности.

Результаты

Результаты. Медиана возраста пациентов составила 65 (межквартильный размах (МКР): 56–74) лет, 60,7% были мужчинами, 47,1% с подъемом сегмента ST. Госпитальная летальность составила 5,4% (n = 31). Медиана RDW составила 14,2% (МКР 13,5–15,0%). Однофакторный анализ показал, что RDW был значимым предиктором госпитальной летальности (Отношение шансов (ОШ) 1,27; 95% доверительный интервал (ДИ): 1,07–1,50; p = 0,005). Площадь под ROC-кривой составила 0,649 (95% ДИ: 0,540–0,758; пороговое значение – 15,11%). Байесовский многофакторный логистический анализ показал, что возраст (ОШ 1,10; 95% ДИ: 1,06–1,14; p < 0,001), подъем сегмента ST (ОШ 3,22; 95% ДИ: 1,41–7,35; p = 0,006), RDW (ОШ 1,26; 95% ДИ: 1,04–1,53; p = 0,021), являлись независимыми предикторами неблагоприятного исхода. В целом модель показала отличную дискриминацию при прогнозировании госпитальной летальности (площадь под ROC-кривой – 0,832; 95% ДИ: 0,779–0,885; p < 0,001; чувствительность 87,1%, специфичность 72,2%) и хорошую калибровку (тест Хосмера – Лемешоу, p = 0,93).

Заключение

Заключение. Повышенное значение RDW независимо ассоциировано с увеличенным риском госпитальной летальности у пациентов с ОИМ, проходящих КАГ. Модель, включающая возраст, подъем сегмента ST и RDW для прогнозирования госпитальной летальности, продемонстрировала высокий прогностический потенциал, позволяя выявить пациентов с высоким риском неблагоприятного исхода.

Aim

Aim: To investigate the association between red blood cell distribution width (RDW) and in-hospital mortality; to develop a clinical risk model of in-hospital mortality in patients with   acute   myocardial   infarction   (AMI).

Materials and methods

Materials and methods. The prospective observational study included 577AMI patients undergoing coronary angiography (CAG) < 24 h after symptom onset and was divided according RDW median. The association between RDW, clinical parameters and inhospital mortality was evaluated using logistic regression and receiver operating characteristic (ROC) curve analysis. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality.

Results

Results. The median age of patients was 65 (interquartile range [IQR]: 56–74) years. 60.7% were male, 47.1% with STelevation. The in-hospital mortality rate was 5.4% (n = 31). Median RDW was 14.2% (IQR 13.5–15.0%). In univariate analysis, RDW was a significant risk predictor of in-hospital mortality (odds ratio [OR] 1.27, 95% confidence intervals [CI] 1.07–1.50, p = 0.005). The area under the ROC curve [AUC] was 0.649 (95% CI: 0.540–0.758, cut-off value 15.11%). In Bayesian multivariate logistic model, age (OR 1.10, 95% CI 1.06–1.14, p < 0.001), ST-elevation (OR 3.22, 95% CI 1.41– 7.35, p = 0.006) RDW (OR 1.26, 95% CI 1.04–1.53, p = 0.021), were identified as risk factors for in-hospital mortality. Overall, the model showed excellent discrimination in predicting in-hospital mortality (AUC = 0.832, 95% CI: 0.779– 0.885, p < 0.001, sensitivity: 87.1%, specificity: 72.2%) and with good calibration (Hosmer-Lemeshow test, p = 0.632).

Conclusions

Conclusions. Elevated RDW value was independently associated with an increased risk of in-hospital mortality in AMI patients undergoing CAG. The model, including age, ST-elevation and RDW for prediction of in-hospital mortality demonstrated high prognostic potential, enabling the identification of patients at high-risk of adverse outcome.

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The authors declare that there are no conflicts of interest present.