Lin Jingyi, Zhang Lin, Deng Shuaishuai, Feng Boxuan, Liu Li, Fan Guanwei
Medical Experiment Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Medical Experiment Center, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Acta Cardiol. 2025 Jun;80(4):376-386. doi: 10.1080/00015385.2025.2491151. Epub 2025 Apr 14.
The ratio of red blood cell distribution width (RDW) to albumin (ALB), known as RAR, functions as an innovative indicator related to prognosis. However, whether RAR can predict the in-hospital mortality (IHM) for heart failure (HF) patients remains ambiguous.
This study included HF patients derived from the Medical Information Mart for Intensive Care III (MIMIC-III) and IV (MIMIC-IV) databases. To examine the association between RAR and IHM, multiple Logistic regression models were conducted, complemented by subgroup analyses. Additionally, to ascertain the optimal threshold for RAR, restricted cubic spline (RCS) regressions were applied.
In the MIMIC-III ( = 9,413) and MIMIC-IV ( = 18,685) HF cohorts, the incidence of IHM was observed in 1,639 (17.41%) and 1,175 (6.29%) participants. Following adjustment for various covariates, RAR was shown to correlate with IHM (OR, 1.45 [95% CI, 1.08-1.39]). The areas under the curves for RAR were 0.683 (MIMIC-III) and 0.710 (MIMIC-IV), indicating superior predictive value than RDW and ALB. In subgroup analysis, younger HF patients with diabetes and without atrial fibrillation or anaemia showed higher ORs than older patients without diabetes or atrial fibrillation and those with anaemia, respectively. RCS indicated the OR for RAR was non-linear with IHM, and the optimal threshold for RAR prediction was between 4.5 and 5.
An elevated RAR correlates with an increased risk of IHM in HF patients. Given that RAR can be readily derived from routine laboratory tests, it holds potential as a novel biomarker for identifying high-risk HF patients.
红细胞分布宽度（RDW）与白蛋白（ALB）的比值，即RAR，是一种与预后相关的创新指标。然而，RAR能否预测心力衰竭（HF）患者的院内死亡率（IHM）仍不明确。
本研究纳入了来自重症监护医学信息集市III（MIMIC-III）和IV（MIMIC-IV）数据库的HF患者。为了检验RAR与IHM之间的关联，进行了多个逻辑回归模型，并辅以亚组分析。此外，为了确定RAR的最佳阈值，应用了受限立方样条（RCS）回归。
在MIMIC-III（n = 9413）和MIMIC-IV（n = 18685）HF队列中，分别有1639名（17.41%）和1175名（6.29%）参与者发生了IHM。在对各种协变量进行调整后，RAR与IHM相关（OR，1.45 [95% CI，1.08 - 1.39]）。RAR的曲线下面积分别为0.683（MIMIC-III）和0.710（MIMIC-IV），表明其预测价值优于RDW和ALB。在亚组分析中，患有糖尿病且无房颤或贫血的年轻HF患者的OR分别高于无糖尿病或房颤且患有贫血的老年患者。RCS表明RAR的OR与IHM呈非线性关系，RAR预测的最佳阈值在4.5至5之间。
RAR升高与HF患者IHM风险增加相关。鉴于RAR可从常规实验室检查中轻易得出，它有潜力作为识别高危HF患者的新型生物标志物。
