Gao Chen, Peng Longkai
Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.
Front Med (Lausanne). 2023 Mar 9;10:1047933. doi: 10.3389/fmed.2023.1047933. eCollection 2023.
The progression of acute kidney injury (AKI) might be associated with systemic inflammation. Our study aims to explore the association and predictive value of the red blood cell distribution width (RDW) to human serum albumin (ALB) ratio (RDW/ALB ratio), an inflammation-related indicator, in the risk of all-cause mortality and renal replacement therapy (RRT) in AKI patients admitted in intensive care units (ICU).
A retrospective cohort study was designed, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was the risk of all-cause mortality (1-month, 3-month, and 12-month), and the secondary outcome was the risk of RRT. The association between the RDW/ALB ratio and the risk of all-cause mortality and RRT was assessed using the Cox regression analysis, with results shown as hazard ratio (HR) and 95% confidence intervals (CIs). The relationship between the RDW/ALB ratio and crude probability of all-cause mortality or RRT was assessed using restricted cubic splines (RCS). The concordance index (C-index) was used to assess the discrimination of the prediction model.
A total of 13,856 patients were included in our study. In the fully adjusted Cox regression model, we found that a high RDW/ALB ratio was associated with an increased risk of 1-month, 3-month, and 12-month all-cause mortality and RRT (all < 0.05). Moreover, RCS curves showed the linear relationship between the RDW/ALB ratio and the probability of all-cause mortality and RRT, and the probability was elevated with the increase of the ratio. In addition, the RDW/ALB ratio showed a good predictive performance in the risk of 1-month all-cause mortality, 3-month all-cause mortality, 12-month all-cause mortality, and RRT, with a C-index of 0.728 (95%CI: 0.719-0.737), 0.728 (95%CI: 0.721-0.735), 0.719 (95%CI: 0.713-0.725), and 0.883 (95%CI: 0.876-0.890), respectively.
The RDW/ALB ratio performed well to predict the risk of all-cause mortality and RRT in critically ill patients with AKI, indicating that this combined inflammatory indicator might be effective in clinical practice.
急性肾损伤（AKI）的进展可能与全身炎症有关。我们的研究旨在探讨红细胞分布宽度（RDW）与血清白蛋白（ALB）比值（RDW/ALB比值）这一炎症相关指标，在入住重症监护病房（ICU）的AKI患者全因死亡风险和肾脏替代治疗（RRT）中的相关性及预测价值。
设计一项回顾性队列研究，数据来自重症监护医学信息集市三期（MIMIC-III）。主要结局是全因死亡风险（1个月、3个月和12个月），次要结局是RRT风险。采用Cox回归分析评估RDW/ALB比值与全因死亡风险和RRT风险之间的相关性，结果以风险比（HR）和95%置信区间（CI）表示。使用受限立方样条（RCS）评估RDW/ALB比值与全因死亡或RRT的粗概率之间的关系。一致性指数（C指数）用于评估预测模型的辨别力。
我们的研究共纳入13856例患者。在完全调整的Cox回归模型中，我们发现高RDW/ALB比值与1个月、3个月和12个月的全因死亡风险及RRT风险增加相关（均P<0.05）。此外，RCS曲线显示RDW/ALB比值与全因死亡概率和RRT概率之间呈线性关系，且概率随比值增加而升高。此外，RDW/ALB比值在1个月全因死亡风险、3个月全因死亡风险、12个月全因死亡风险和RRT风险方面表现出良好的预测性能，C指数分别为0.728（95%CI：0.719-0.737）、0.728（95%CI：0.721-0.735）、0.719（95%CI：0.713-0.725）和0.883（95%CI：0.876-0.890）。
RDW/ALB比值在预测AKI危重症患者全因死亡风险和RRT风险方面表现良好，表明这一综合炎症指标在临床实践中可能有效。
