红细胞分布宽度与白蛋白比值作为合并糖尿病或糖尿病前期的心血管疾病患者全因死亡率和心血管死亡率的预测指标：2001 - 2018年美国国家健康与营养检查调查

Red blood cell distribution width to albumin ratio as a predictor of all-cause and cardiovascular mortality in patients with cardiovascular disease with diabetes or pre-diabetes: National Health and Nutrition Examination Survey 2001-2018.

作者信息

Shao Xinyi, Ou Yi, Bai Genlong, Shi Xiangyun, Chen Jin, Zhang Jingbo

机构信息

Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

College of Geography and Resources, Sichuan Normal University, Chengdu 610101, China.

出版信息

Diabetes Res Clin Pract. 2025 Aug;226:112317. doi: 10.1016/j.diabres.2025.112317. Epub 2025 Jun 4.

DOI:10.1016/j.diabres.2025.112317

PMID:40480376

Abstract

BACKGROUND

The red blood cell distribution width to albumin ratio (RAR) index has been identified as a new composite marker for multiple diseases. However, the association between RAR index and mortality in patients with Cardiovascular Disease (CVD) with diabetes or pre-diabetes is not yet established. Therefore, this study aimed to investigate the association of the RAR index with all-cause and cause-specific mortality in patients with CVD with diabetes or pre-diabetes.

METHODS

This study examined 2952 participants with CVD with diabetes or pre-diabetes, using data from the 2001-2018 National Health and Nutrition Examination Survey. The study endpoints included all-cause and cardiovascular mortality, determined using data from the National Death Index. Furthermore, the associations of the RAR index with cardiovascular and all-cause mortality were evaluated using a weighted Cox proportional hazards model and restricted cubic splines (RCS).

RESULTS

A total of 2952 eligible patients were included in this study, among whom 1225 (41.5 %) died, including 489 (16.57%) due to CVDs. Individuals in Q4 exhibited notably higher all-cause (hazard ratio [HR]: 2.73, 95% confidence interval [CI]: 2.19-3.41) and cardiovascular (HR: 3.05, 95% CI: 2.33-4.01) mortality rates than those in Q1. The results were uniform across all subgroups. RCS curves showed a positive correlation between the RAR index and all mortality types.

CONCLUSIONS

Elevated RAR index is associated with higher all-cause and cardiovascular mortality in patients with CVD with diabetes or pre-diabetes.

摘要

背景

红细胞分布宽度与白蛋白比值（RAR）指数已被确定为多种疾病的新型综合标志物。然而，RAR指数与患有糖尿病或糖尿病前期的心血管疾病（CVD）患者死亡率之间的关联尚未确立。因此，本研究旨在探讨RAR指数与患有糖尿病或糖尿病前期的CVD患者全因死亡率和特定病因死亡率之间的关联。

方法

本研究使用2001 - 2018年国家健康与营养检查调查的数据，对2952名患有糖尿病或糖尿病前期的CVD参与者进行了检查。研究终点包括全因死亡率和心血管死亡率，通过国家死亡指数的数据确定。此外，使用加权Cox比例风险模型和受限立方样条（RCS）评估RAR指数与心血管死亡率和全因死亡率之间的关联。

结果

本研究共纳入2952例符合条件的患者，其中1225例（41.5%）死亡，包括489例（16.57%）死于心血管疾病。与第一四分位数组相比，第四四分位数组个体的全因死亡率（风险比[HR]：2.73，95%置信区间[CI]：2.19 - 3.41）和心血管死亡率（HR：3.05，95% CI：2.33 - 4.01）显著更高。所有亚组的结果均一致。RCS曲线显示RAR指数与所有死亡率类型之间呈正相关。