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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1410339

Association between red cell distribution width -albumin ratio and all-cause mortality in intensive care unit patients with heart failure

Provisionally accepted
Kai Wang Kai Wang 1*Ni Li Ni Li 2Junling Li Junling Li 2
  • 1 Department of Cardiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
  • 2 Department of Cardiology, Chongqing Bishan Hospital of Traditional Chinese Medicine, Chongqing, China

The final, formatted version of the article will be published soon.

    Aims: The association between red cell distribution width -albumin ratio (RAR) and the risk of allcause mortality in intensive care unit (ICU) patients with heart failure remains uncertain. This study aimed to investigate this association. Methods: Clinical data from MIMIC-Ⅳ (version 2.2) database was utilized for the analysis of ICU patients with heart failure. Patients were categorized into quartiles (Q1-Q4) based on RAR levels. Kaplan-Meier survival analysis and multivariate adjusted Cox regression models were employed to assess the association between RAR levels and mortality outcomes within 1 year. Subgroup analysis was used to evaluate the prognostic impact of RAR across diverse populations. Restricted cubic spline curves and threshold effect analysis were utilized to quantify the dose-response relationship between RAR levels and mortality. The time-concordance index curve was carried out to explore the additional prognostic value of RAR on mortality over the existing scoring systems, Serial Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ). Results: The analysis encompassed a cohort of 4506 patients, with Kaplan-Meier curves indicating that individuals with higher RAR levels exhibited an elevated risk of all-cause mortality (p < 0.001). Multivariate adjusted Cox regression and subgroup analysis demonstrated that individuals in Q2 (hazard ratio (HR) 1.15, 95%CI 0.98~1.34), Q3 (HR 1.65, 95%CI 1.39~1.96) and Q4 (HR 2.16, 95%CI 1.74~2.68) had an increased risk of mortality compared to individuals in Q1 (p for trend < 0.001), and this relationship was consistently observed across most subgroups, except for different ages. Subsequent analysis revealed that the inclusion of RAR significantly improved the prognostic value on the basis of SOFA and APACHE Ⅱ, and the concordance index increased from 0.636 to 0.658 for SOFA, from 0.682 to 0.695 for APACHE Ⅱ (p < 0.001 for both). Conclusion: The study found that high level of RAR was independently associated with an increased risk of 1-year all-cause mortality in ICU patients with heart failure, with a stronger effect in young and middle-aged patients and a threshold effect, which could potentially serve as an early warning indicator for high-risk populations.

    Keywords: Heart Failure, Intensive Care Unit, Inflammation, prognosis, Red cell distribution widthalbumin ratio

    Received: 01 Apr 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Wang, Li and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kai Wang, Department of Cardiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.