Xu Jia, Wang Guangdong, Chen Xinran, Xu Xinyi, Wang Yun, Wang Li, Zhang Yaxin
Department of Electrocardiography Diagnosis, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China.
Front Nutr. 2025 Jun 4;12:1599104. doi: 10.3389/fnut.2025.1599104. eCollection 2025.
Intracerebral hemorrhage (ICH) remains a devastating cerebrovascular condition, marked by high fatality and limited availability of prognostic tools. The red blood cell distribution width-to-albumin ratio (RAR) has recently gained attention as a composite biomarker of systemic inflammation and nutritional condition, but its prognostic value in ICH remains unclear. We aim to examine how RAR relates to mortality risk among individuals with ICH.
We performed a retrospective cohort analysis using the Medical Information Mart for Intensive Care-IV database. A total of 1,410 ICH individuals hospitalized in the intensive care unit were included and categorized into quartiles according to their RAR levels. The primary endpoint was all-cause mortality at 365 days, while 90-day all-cause mortality served as a secondary endpoint. Kaplan-Meier survival analysis, time-varying Cox regression model, and restricted cubic spline analyses (RCS)analysis were performed to assess the link between RAR and mortality risk. The predictive utility of RAR was further assessed through receiver operating characteristic (ROC)curve. Subgroup analyses explored potential effect modifications.
Among the 1,410 ICH patients analyzed, the median age was 69 years. The all-cause mortality rates at 90-day and 365-day were 35.53 and 42.62%, respectively. Individuals with the highest RAR levels experienced significantly greater 90 days (54.34% vs. 21.97%, < 0.001) and 365 days (62.18% vs. 29.77%, < 0.001) than those with the lowest levels. Time-varying Cox regression model revealed that increased RAR levels were significantly and independently linked to greater mortality risk (hazard ratios [HR] for 365-day mortality:1.07, 95% CI:1.02-1.13, = 0.005; HR for 90-day mortality: 1.14, 95%CI: 1.05-1.12, = 0.001). ROC curve analysis demonstrated that combining RAR with the SOFA score improved predictive accuracy for 90-day and 365-day. RCS analyses indicated a nonlinear connection between higher RAR values and mortality rates. Subgroup analyses revealed that a largely uniform effect of RAR across different subpopulations except for age, gender, and race.
An elevated RAR is independently and significantly associated with increased all-cause mortality in ICH patients, regardless of established risk predictors. Its combination with the SOFA score enhances prognostic accuracy. These results suggest its potential clinical utility for early risk stratification.
脑出血（ICH）仍然是一种毁灭性的脑血管疾病，其特点是死亡率高且预后工具有限。红细胞分布宽度与白蛋白比值（RAR）最近作为全身炎症和营养状况的复合生物标志物受到关注，但其在脑出血中的预后价值仍不清楚。我们旨在研究RAR与脑出血患者死亡风险之间的关系。
我们使用重症监护医学信息数据库IV进行了一项回顾性队列分析。总共纳入了1410名入住重症监护病房的脑出血患者，并根据其RAR水平分为四分位数。主要终点是365天的全因死亡率，而90天全因死亡率作为次要终点。进行了Kaplan-Meier生存分析、时变Cox回归模型和受限立方样条分析（RCS）以评估RAR与死亡风险之间的联系。通过受试者工作特征（ROC）曲线进一步评估RAR的预测效用。亚组分析探讨了潜在的效应修正因素。
在分析的1410例脑出血患者中，中位年龄为69岁。90天和365天的全因死亡率分别为35.53%和42.62%。RAR水平最高的个体在90天（54.34%对21.97%，<0.001）和365天（62.18%对29.77%，<0.001）的死亡率显著高于水平最低的个体。时变Cox回归模型显示，RAR水平升高与更高的死亡风险显著且独立相关（365天死亡率的风险比[HR]：1.07，95%置信区间：1.02-1.13，P = 0.005；90天死亡率的HR：1.14，95%置信区间：1.05-1.12，P = 0.001）。ROC曲线分析表明，将RAR与序贯器官衰竭评估（SOFA）评分相结合可提高90天和365天的预测准确性。RCS分析表明较高的RAR值与死亡率之间存在非线性联系。亚组分析显示，除年龄、性别和种族外，RAR在不同亚组中具有基本一致的效应。
RAR升高与脑出血患者全因死亡率增加独立且显著相关，与既定的风险预测因素无关。它与SOFA评分相结合可提高预后准确性。这些结果表明其在早期风险分层中的潜在临床效用。
