Chen Xuan, Luo Yuchen, Liu Side
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Front Med (Lausanne). 2025 Feb 12;12:1503378. doi: 10.3389/fmed.2025.1503378. eCollection 2025.
Red blood cell volume distribution width (RDW) and albumin (Alb) have been proved to be predictors of mortality in various diseases, such as acute pancreatitis (AP). However, until now the relationship between RDW to Alb ratio (RAR) and mortality in AP has not been fully elucidated. Therefore, this study aims to evaluate the relationship between RAR and all-cause mortality in AP.
Patients with AP in the Critical Care Medical Information Market (MIMIC-IV) database who met criteria were included in this retrospective study. Associated baseline data was obtained, cleaned and analyzed. Kaplan Meier (K-M) survival curve and Cox proportional hazards regression model were utilized to evaluate the relationship between RAR and all-cause mortality. Restricted Cubic Spline (RCS) was used for exploring how hazard ratio (HR) changes as RAR varied. Additionally, Receiver Operating Characteristic (ROC) analysis and subgroup analysis were conducted to assess the predictive value and to explore the significance of RAR in different populations.
499 patients were included in this study. Survival curve showed that patients with RAR > 5.14 had higher mortality rate at 7-day (d), 14-d, 21-d, 28-d, 90-d, 180-d and 1-year (y). The univariate and multivariate Cox models revealed an independent association between high-level RAR and all-cause mortality at 28-d, 90-d and 1-y. RCS showed that RAR became a risk factor when exceeding 5.14. RAR only had linear relationship with mortality at 1-y after adjusting for the potential confounders. Subgroup analysis suggested that increased RAR caused higher risk of death in male, non-white people or those patients without respiratory failure (RF). ROC analysis indicated that compared with other parameters such as SOFA score, RAR exhibited higher efficiency in predicting in-hospital and all-cause mortality at 14-d, 21-d, 28-d, 90-d. Combined RAR with BISAP, RAR-modified BISAP showed superiority in predicting short-term mortality (28-d).
For patients with AP in ICU, RAR has a strong association with short- and long-term prognosis. Especially, RAR is a promising indicator for short-term all-cause mortality in patients with AP. For males, non-white patients and those without RF, elevated RAR may be a more dangerous signal of mortality.
红细胞体积分布宽度（RDW）和白蛋白（Alb）已被证明是多种疾病（如急性胰腺炎（AP））死亡率的预测指标。然而，迄今为止，RDW与Alb比值（RAR）与AP死亡率之间的关系尚未完全阐明。因此，本研究旨在评估RAR与AP全因死亡率之间的关系。
本回顾性研究纳入了重症监护医学信息市场（MIMIC-IV）数据库中符合标准的AP患者。获取相关基线数据，进行清理和分析。采用Kaplan Meier（K-M）生存曲线和Cox比例风险回归模型评估RAR与全因死亡率之间的关系。使用限制立方样条（RCS）来探究风险比（HR）如何随RAR变化。此外，进行受试者工作特征（ROC）分析和亚组分析，以评估预测价值并探讨RAR在不同人群中的意义。
本研究纳入了499例患者。生存曲线显示，RAR>5.14的患者在7天（d）、14天、21天、28天、90天、180天和1年（y）时死亡率较高。单因素和多因素Cox模型显示，高水平RAR与28天、90天和1年时的全因死亡率独立相关。RCS显示，RAR超过5.14时成为危险因素。在调整潜在混杂因素后，RAR仅与1年时的死亡率呈线性关系。亚组分析表明，RAR升高在男性、非白人或无呼吸衰竭（RF）的患者中导致更高的死亡风险。ROC分析表明，与序贯器官衰竭评估（SOFA）评分等其他参数相比，RAR在预测14天、21天、28天、90天时的院内和全因死亡率方面表现出更高的效率。将RAR与床边指数评估（BISAP）相结合，RAR改良的BISAP在预测短期死亡率（28天）方面表现出优势。
对于重症监护病房（ICU）中的AP患者，RAR与短期和长期预后密切相关。特别是，RAR是AP患者短期全因死亡率的一个有前景的指标。对于男性、非白人患者和无RF的患者，RAR升高可能是更危险的死亡信号。
