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Purpose <p>This study aimed to explore the association of red cell distribution width to albumin ratio (RAR) with all-cause mortality in ICU-NAFLD patients, to evaluate RAR as a prognostic tool.</p> Methods <p>Patients were stratified into four groups, with 365- and 28-day all-cause mortality as primary and secondary endpoints. The Kaplan-Meier analysis compared survival across groups, while Cox regression and restricted cubic spline (RCS) evaluated associations between red cell distribution width-to-albumin ratio (RAR) and outcomes. The predictive performance of RAR was quantified using receiver operating characteristic (ROC) curves. A nomogram predicting treatment response was developed and internally validated via bootstrap resampling. Calibration and clinical utility were further assessed by Hosmer-Lemeshow test and decision curve analysis (DCA).</p> Results <p>A total of 590 patients with NAFLD were enrolled. Higher levels of the RAR index were correlated with an increased risk of 28- and 365-day all-cause mortality, as indicated by the K-M curves (log-rank <i>P</i> &lt; 0.001). Multivariate Cox proportional risk analysis, after adjusting for confounding factors, displayed that high RAR levels were associated with an increased risk of 28-day mortality (HR 1.82[95%CI [1.10,3.04], <i>P</i> = 0.021) and 365-day mortality (HR 1.58 [95%CI[1.10,2.28], <i>P</i> = 0.014), with a nonlinear relationship observed for long-term risk (P-overall &lt; 0.001, P-nonlinear = 0.046). Finally, the combination of RAR, TBiL, Scr, and INR had a good diagnostic efficiency for NAFLD (sensitivity: 72.93%, specificity: 69.44%, AUC: 0.759). The H-L test and DCA showed a certain alignment between predicted and actual results (accuracy of 0.733 and a Kappa statistic of 0.490).</p> Conclusion <p>Elevated RAR independently predicts increased 28- and 365-day mortality in critically ill NAFLD patients. The combination of RAR with routine biomarkers (AUC = 0.759) improves mortality prediction. Routine monitoring of this simple, cost-effective ratio may aid in risk stratification and early intervention for high-risk ICU patients with NAFLD.</p>

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Prognostic significance of red cell distribution width to albumin ratio in ICU patients with Non-alcoholic fatty liver disease: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Huan Yang,
  • Libo Liang,
  • Yan Liu,
  • Xia Wang,
  • Jinling Li,
  • Xiao Du,
  • He He

摘要

Purpose

This study aimed to explore the association of red cell distribution width to albumin ratio (RAR) with all-cause mortality in ICU-NAFLD patients, to evaluate RAR as a prognostic tool.

Methods

Patients were stratified into four groups, with 365- and 28-day all-cause mortality as primary and secondary endpoints. The Kaplan-Meier analysis compared survival across groups, while Cox regression and restricted cubic spline (RCS) evaluated associations between red cell distribution width-to-albumin ratio (RAR) and outcomes. The predictive performance of RAR was quantified using receiver operating characteristic (ROC) curves. A nomogram predicting treatment response was developed and internally validated via bootstrap resampling. Calibration and clinical utility were further assessed by Hosmer-Lemeshow test and decision curve analysis (DCA).

Results

A total of 590 patients with NAFLD were enrolled. Higher levels of the RAR index were correlated with an increased risk of 28- and 365-day all-cause mortality, as indicated by the K-M curves (log-rank P < 0.001). Multivariate Cox proportional risk analysis, after adjusting for confounding factors, displayed that high RAR levels were associated with an increased risk of 28-day mortality (HR 1.82[95%CI [1.10,3.04], P = 0.021) and 365-day mortality (HR 1.58 [95%CI[1.10,2.28], P = 0.014), with a nonlinear relationship observed for long-term risk (P-overall < 0.001, P-nonlinear = 0.046). Finally, the combination of RAR, TBiL, Scr, and INR had a good diagnostic efficiency for NAFLD (sensitivity: 72.93%, specificity: 69.44%, AUC: 0.759). The H-L test and DCA showed a certain alignment between predicted and actual results (accuracy of 0.733 and a Kappa statistic of 0.490).

Conclusion

Elevated RAR independently predicts increased 28- and 365-day mortality in critically ill NAFLD patients. The combination of RAR with routine biomarkers (AUC = 0.759) improves mortality prediction. Routine monitoring of this simple, cost-effective ratio may aid in risk stratification and early intervention for high-risk ICU patients with NAFLD.