Zhang Guoxin, Xu Beizheng, Zhao Xiaoyun
Department of Respiratory and Critical Care Medicine, Tianjin University Chest Hospital, Thoracic Clinical College of Tianjin Medical University, Tianjin Chest Hospital, Tianjin, China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
PLoS One. 2025 Apr 1;20(4):e0319869. doi: 10.1371/journal.pone.0319869. eCollection 2025.
To investigate the association of red blood cell distribution width (RDW) to albumin ratio (RAR) with mortality in chronic obstructive pulmonary disease (COPD) patients.
We selected 1,652 patients with COPD from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, who were categorized into four groups according to the RAR quartiles. Kaplan-Meier curves, restricted cubic splines and the Cox proportional hazard model were used to evaluate the associations between RAR and all-cause mortality and chronic lower respiratory disease (CLRD) mortality in the COPD patients. Subgroup analyses were performed to check the interaction of the different characteristics.
There were 640 deaths during follow-up, of which, 145 were from CLRD. Kaplan-Meier curves indicated COPD patients with higher RAR had significantly increased all-cause mortality and CLRD mortality. Multivariate Cox regression analyses showed HR of Q4 RAR was 2.88 (95% CI 2.18 - 3.81, p < 0.0001) for all cause-mortality and 3.39 (95% CI 1.76 - 6.53, p < 0.001) for CLRD mortality, compared with Q1 RAR. Restricted cubic splines analysis indicated a dose-response between RAR and risk of all-cause and CLRD mortality (p for non-linearity < 0.001).
RAR had an independent association with all-cause mortality, especially CLRD mortality, in COPD patients. RAR has potential as a novel and promising predictor to identify COPD individuals with high mortality risk.
探讨红细胞分布宽度（RDW）与白蛋白比值（RAR）与慢性阻塞性肺疾病（COPD）患者死亡率之间的关联。
我们从1999 - 2018年国家健康与营养检查调查（NHANES）中选取了1652例COPD患者，根据RAR四分位数将其分为四组。采用Kaplan - Meier曲线、限制性立方样条和Cox比例风险模型来评估RAR与COPD患者全因死亡率和慢性下呼吸道疾病（CLRD）死亡率之间的关联。进行亚组分析以检验不同特征的相互作用。
随访期间有640例死亡，其中145例死于CLRD。Kaplan - Meier曲线表明，RAR较高的COPD患者全因死亡率和CLRD死亡率显著增加。多变量Cox回归分析显示，与第一四分位数RAR相比，第四四分位数RAR的全因死亡率风险比（HR）为2.88（95%置信区间2.18 - 3.81，p < 0.0001），CLRD死亡率的HR为3.39（95%置信区间1.76 - 6.53，p < 0.001）。限制性立方样条分析表明RAR与全因和CLRD死亡率风险之间存在剂量反应关系（非线性p < 0.001）。
RAR与COPD患者的全因死亡率，尤其是CLRD死亡率独立相关。RAR有潜力作为一种新型且有前景的预测指标，用于识别具有高死亡风险的COPD个体。
