ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1563512
This article is part of the Research TopicA Patient-Centered Approach to the Management of Heart Failure and ComorbiditiesView all 6 articles
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
Provisionally accepted
Lie-Jun Qian1
Lu-xi Hong2*- 1Tiantai County Hospital of Traditional Chinese Medicine, Tiantai, China
- 2Tiantai County People's Hospital, tiantai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: This 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).Methods: The 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.Results: A 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. Conclusions: We 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.
Keywords: congestive heart failure combined with chronic kidney disease, blood cell distribution width-to-albumin ratio, In-hospital mortality, machine learning algorithms, Mediation analysis
Received: 20 Jan 2025; Accepted: 25 Jun 2025.
Copyright: © 2025 Qian and Hong. 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: Lu-xi Hong, Tiantai County People's Hospital, tiantai, 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.