Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease

BackgroundThis study aimed to explore the relationship between the blood cell distribution width-to-albumin ratio (RAR) and in-hospital mortality in patients with congestive heart failure (CHF) combined with chronic kidney disease (CKD).MethodsThe patients' information was collected from the Me...

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Main Authors: Lie-jun Qian, Lu-xi Hong
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Cardiovascular Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2025.1563512/full
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author Lie-jun Qian
Lu-xi Hong
author_facet Lie-jun Qian
Lu-xi Hong
author_sort Lie-jun Qian
collection DOAJ
description BackgroundThis study aimed to explore the relationship between the blood cell distribution width-to-albumin ratio (RAR) and in-hospital mortality in patients with congestive heart failure (CHF) combined with chronic kidney disease (CKD).MethodsThe patients' information was collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The association of the RAR and in-hospital mortality were assessed via logistic regression analysis with adjusting for different covariate, followed by visualization via the restricted cubic splines (RCS) analysis. Correlation analysis and machine learning algorithms were used to screen the clinical features associated with RAR. Mediation analysis was used to explore the function of RAR-related feature on their association. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) curves were used to explore the efficacy of RAR in predicting patient outcomes and the net clinical benefit, respectively.ResultsA total of 1,243 patients were included in this study. Logistic regression analysis showed that RAR was a risk factor of in-hospital death. RCS showed a linear relationship between RAR and in-hospital mortality, which was not affected by confounding factors. Monocytes played a mediating role in the relationship between RAR and in-hospital mortality. RAR had a good efficacy and clinical net for predicting in-hospital mortality, half-year mortality, one-year mortality, and three-year mortality.ConclusionsWe found that RAR was a risk factor for in-hospital death and could predict short-term and long-term outcomes in patients with CHF combined with CKD. Monocytes played a mediating role in their relationship.
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spelling doaj-art-034add5249754f6d9d30a9680a9c4cbd2025-08-20T02:44:27ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-07-011210.3389/fcvm.2025.15635121563512Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney diseaseLie-jun Qian0Lu-xi Hong1ICU, Tiantai County Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang, ChinaDepartment of Ultrasound, Tiantai County People’s Hospital, Taizhou, Zhejiang, ChinaBackgroundThis study aimed to explore the relationship between the blood cell distribution width-to-albumin ratio (RAR) and in-hospital mortality in patients with congestive heart failure (CHF) combined with chronic kidney disease (CKD).MethodsThe patients' information was collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The association of the RAR and in-hospital mortality were assessed via logistic regression analysis with adjusting for different covariate, followed by visualization via the restricted cubic splines (RCS) analysis. Correlation analysis and machine learning algorithms were used to screen the clinical features associated with RAR. Mediation analysis was used to explore the function of RAR-related feature on their association. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) curves were used to explore the efficacy of RAR in predicting patient outcomes and the net clinical benefit, respectively.ResultsA total of 1,243 patients were included in this study. Logistic regression analysis showed that RAR was a risk factor of in-hospital death. RCS showed a linear relationship between RAR and in-hospital mortality, which was not affected by confounding factors. Monocytes played a mediating role in the relationship between RAR and in-hospital mortality. RAR had a good efficacy and clinical net for predicting in-hospital mortality, half-year mortality, one-year mortality, and three-year mortality.ConclusionsWe found that RAR was a risk factor for in-hospital death and could predict short-term and long-term outcomes in patients with CHF combined with CKD. Monocytes played a mediating role in their relationship.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1563512/fullcongestive heart failure combined with chronic kidney diseaseblood cell distribution width-to-albumin ratioin-hospital mortalitymachine learning algorithmsmediation analysis
spellingShingle Lie-jun Qian
Lu-xi Hong
Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
Frontiers in Cardiovascular Medicine
congestive heart failure combined with chronic kidney disease
blood cell distribution width-to-albumin ratio
in-hospital mortality
machine learning algorithms
mediation analysis
title Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
title_full Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
title_fullStr Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
title_full_unstemmed Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
title_short Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney disease
title_sort association between red blood cell distribution width to albumin ratio and in hospital mortality in patients with congestive heart failure combined with chronic kidney disease
topic congestive heart failure combined with chronic kidney disease
blood cell distribution width-to-albumin ratio
in-hospital mortality
machine learning algorithms
mediation analysis
url https://www.frontiersin.org/articles/10.3389/fcvm.2025.1563512/full
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AT luxihong associationbetweenredbloodcelldistributionwidthtoalbuminratioandinhospitalmortalityinpatientswithcongestiveheartfailurecombinedwithchronickidneydisease