血红蛋白与红细胞分布宽度与院内心脏骤停 患者短期预后的相关性研究

A Correlational Study between Hemoglobin-Red Blood Cell Distribution Width Ratio and Short-Term Prognosis in Patients with In-Hospital Cardiac Arrest

摘要: 目的：心脏骤停是一种危及生命的临床急症，预后严重，对医疗资源和社会造成了巨大负担。其病理生理特征为心脏泵功能的突然停止，导致全身缺血缺氧，尤其是脑部缺氧。这种缺血性损伤进一步激活强烈的全身炎症反应，加重器官损伤。传统的临床指标往往难以提供同时评估炎症反应和缺血–缺氧风险的多维度评估，从而限制了高危患者的识别。血红蛋白与红细胞分布宽度比值(HRR)近年来作为一种新型综合生物标志物，能够反映全身炎症活性及缺血–缺氧状态。尽管其预后价值已在多种疾病中得到验证，但关于其与院内心脏骤停(IHCA)复苏后患者预后的关联证据仍较少。此外，现有研究主要集中于30天预后，其在预测短期预后中的作用仍未得到充分探索。因此，本研究旨在探讨HRR对心脏骤停患者短期(7天)预后的影响。方法：本研究回顾性分析了2023年至2025年间在烟台毓璜顶医院接受成功心肺复苏(CPR)并恢复自主循环(ROSC)的成人IHCA患者的数据。收集了ROSC后首次可获得的实验室检查数据。通过单因素和多因素Cox回归分析筛选影响7天死亡率的显著变量。同时，采用Kaplan-Meier曲线进一步探讨HRR对患者短期死亡率的影响。Cox回归分析显示，HRR (HR: 0.902, P = 0.029, 95% CI: 0.824~0.987)及其他因素与患者短期死亡率相关。经相关因素调整后，Kaplan-Meier曲线显示，HRR下降与患者短期死亡率升高相关(P < 0.05)。结论：复苏后早期HRR水平低于9.13与心脏骤停患者短期死亡风险显著增加密切相关。

Abstract: Cardiac arrest is a critical clinical condition with a grave prognosis, imposing a substantial burden on healthcare resources and society. Its underlying pathophysiology is characterized by the abrupt cessation of cardiac pump function, leading to systemic ischemia and hypoxia, particularly in the brain. This ischemic insult, in turn, activates a potent systemic inflammatory response that exacerbates organ injury. Conventional clinical parameters are often insufficient in providing a multidimensional assessment that concurrently addresses both inflammatory and ischemic-hypoxic risks, thereby limiting the identification of high-risk patients. The Hemoglobin-to-Red Cell Distribution Width Ratio (HRR) has recently emerged as a novel and integrated biomarker capable of reflecting systemic inflammatory activity and ischemic-hypoxic status. Although its prognostic value has been validated in various diseases, evidence regarding its association with outcomes following In-Hospital Cardiac Arrest (IHCA) resuscitation remains scarce. Furthermore, existing studies predominantly focus on 30-day outcomes, leaving the role of HRR in predicting short-term prognosis underexplored. Therefore, this study aims to investigate the impact of HRR on the short-term (7-day) prognosis of patients after cardiac arrest. Method: This study retrospectively analyzed data from adult IHCA patients who underwent successful Cardiopulmonary Resuscitation (CPR) and achieved the Return Of Spontaneous Circulation (ROSC) at Yantai Yuhuangding Hospital between 2023 and 2025. The first available laboratory data after ROSC was collected. The inclusion and exclusion criteria were strictly implemented to screen eligible patients. Significant variables affecting 7-day mortality were identified using univariate and multivariable Cox regression analyses, with potential confounding factors adjusted. Additionally, Kaplan-Meier curves combined with Log-rank test were used to further explore the impact of HRR on the short-term mortality of the patients, and the optimal cut-off value of HRR was determined. Result: A total of 216 patients who met the inclusion and exclusion criteria were enrolled in this study. The baseline characteristics of the patients (including age, gender, underlying diseases, and cardiac arrest-related features) were collected and analyzed. Cox regression analysis revealed that HRR (HR: 0.902, P = 0.029, 95% CI: 0.824~0.987) and other relevant factors were associated with the short-term mortality of the patients. The optimal cut-off value of HRR was determined to be 9.13. After adjusting for relevant confounding factors, Kaplan-Meier curves combined with Log-rank test demonstrated that a decrease in HRR (HRR < 9.13) was significantly correlated with an increased short-term mortality rate in the patients (P < 0.05). Conclusion: The initial post-resuscitation HRR level (cut-off value: 9.13) was significantly associated with the short-term prognosis of cardiac arrest patients. An HRR level lower than 9.13 indicates a significantly increased risk of short-term mortality in patients after IHCA resuscitation. HRR, as a simple and accessible integrated biomarker, can provide valuable reference for early risk stratification and short-term prognostic evaluation of patients after cardiac arrest. Limitations of this study include its retrospective design and single-center data, which need to be verified by large-sample, multi-center prospective studies.