ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Diabetes: Molecular Mechanisms
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1622460
Association of hemoglobin-to-red cell distribution width ratio with diabetic retinopathy risk and severity
Provisionally accepted
- 1Chongqing Emergency Medical Center, Chongqing, China
- 2the Second Affiliated Hospital of Chongqing Medical University, chongqing, China
- 3Sichuan Nursing Vocational College, Sichaun province, China
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Background: Diabetic retinopathy (DR) is a leading cause of blindness in diabetic patients, driven by inflammation, oxidative stress, and hypoxia. The hemoglobin-to-red cell distribution width ratio (HRR) is a novel inflammatory marker reflecting these pathological mechanisms. This study aimed to investigated the association of HRR with DR risk and severity. Methods: Data from the 2005–2008 National Health and Nutrition Examination Survey were analyzed using weighted logistic regression, subgroup analysis, restricted cubic splines, mediation analysis, and other methods. Results: Among 1,260 diabetic patients, HRR was inversely associated with DR development (OR = 0.85, P = 0.008), remaining significant post-propensity score matching. A non-linear relationship was identified, with an inflection point at HRR = 10.81 (P for non-linearity < 0.001), above which the protective effect strengthened with increasing HRR. Mediation analyses revealed diastolic blood pressure (15.9% mediation) and HbA1c (60.5% competitive mediation) as partial mediators of the HRR-DR association. HRR was also inversely associated with DR severity, particularly proliferative DR (vs. mild non-proliferative DR: OR = 0.67, P = 0.030; vs. severe non-proliferative DR: OR = 0.04, P = 0.002). Conclusions: HRR is negatively correlated with DR onset and progression, highlighting its potential as a cost-effective biomarker for DR risk stratification.
Keywords: Diabetic retinopathy (DR), Hemoglobin-to-red cell distribution width ratio (HRR), Inflammation, NHANES (National Health and Nutrition Examination Survey), risk stratification
Received: 03 May 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 Wang, Li, Wang and Chen. 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: Zaihong Chen, Chongqing Emergency Medical Center, Chongqing, China
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