Ding Tao, Hu Xueqin, Shao Lihua, Wen Jun, Xia Jun, Zhou Ning, Yang Jiayi, Zhang Li
Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, Hunan, 415000, People's Republic of China.
Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, Hunan, 415000, People's Republic of China.
Int J Gen Med. 2024 Sep 27;17:4407-4418. doi: 10.2147/IJGM.S486495. eCollection 2024.
The red blood cell distribution width (RDW) to albumin (ALB) ratio (RAR) has been identified as a prognostic indicator for mortality in critically ill patients across various diseases. Nevertheless, the impact of RAR on clinical functional prognosis in Acute ischemic stroke (AIS) remains uncertain. This study aimed to evaluate the prognostic significance of RAR in AIS patients.
A secondary analysis was performed on a cohort study, involving 1906 AIS patients recruited from a South Korean academic hospital. Both univariate and multivariate logistic regression was employed to assess the connections between RAR and negative functional results in AIS. To explore potential non-linear relationships in this association, a generalized additive model (GAM) and smooth curve fitting were utilized. Further, a mediation analysis was performed to identify possible mediators.
Out of the 1906 eligible patients, 546 (28.65%) were found to have an unfavorable prognosis. Patients with elevated RAR had a higher likelihood of facing a negative prognosis in AIS (all P<0.001). RAR demonstrated a dose-response relationship with the probability of poor functional prognosis. When analysis of RAR as a continuous variable, an increase in RAR was correlated with a higher risk of adverse prognosis.When RAR was analyzed as quartile variables, the highest RAR remained an independent contributing factor for both 3-month unfavorable outcomes (adjusted OR, 1.4; 95% CI: 1.0-2.1, P=0.046) and 3-month mortality (adjusted OR, 5.2; 95% CI, 2.0-13.9; p<0.001). More interestingly, the presence of a pro-inflammatory state may serve as a mediator in the connections between RAR and adverse functional outcomes.
Given its cost-effectiveness and ease of measurement, baseline RAR holds promise as a valuable biomarker for early risk assessment in AIS patients.
红细胞分布宽度（RDW）与白蛋白（ALB）比值（RAR）已被确定为各类疾病重症患者死亡率的预后指标。然而，RAR对急性缺血性卒中（AIS）临床功能预后的影响仍不确定。本研究旨在评估RAR在AIS患者中的预后意义。
对一项队列研究进行二次分析，该研究纳入了从韩国一家学术医院招募的1906例AIS患者。采用单因素和多因素逻辑回归评估RAR与AIS患者不良功能结局之间的关联。为探究这种关联中潜在的非线性关系，使用了广义相加模型（GAM）和平滑曲线拟合。此外，进行中介分析以确定可能的中介因素。
在1906例符合条件的患者中，546例（28.65%）预后不良。RAR升高的患者在AIS中面临不良预后的可能性更高（所有P<0.001）。RAR与功能预后不良的概率呈剂量反应关系。将RAR作为连续变量分析时，RAR的升高与不良预后风险增加相关。当将RAR作为四分位数变量分析时，最高四分位数的RAR仍然是3个月不良结局（调整后的OR，1.4；95%CI：1.0 - 2.1，P = 0.046）和3个月死亡率（调整后的OR，5.2；95%CI，2.0 - 13.9；P<0.001）的独立影响因素。更有趣的是，促炎状态可能是RAR与不良功能结局之间关联的中介因素。
鉴于其成本效益和易于测量，基线RAR有望成为AIS患者早期风险评估的有价值生物标志物。
