ArticleBMC gastroenterology2025
Prognostic significance of red cell distribution width to albumin ratio in ICU patients with Non-alcoholic fatty liver disease: a retrospective analysis.
Article in BMC gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Association of red blood cell distribution width to albumin ratio with all-cause and cardiovascular mortality among adults with MASLD.BMC gastroenterology · 2026Article
- The association between the red blood cell distribution width-to-albumin ratio and female infertility: A cross-sectional study.Medicine · 2026Article
- The association between red blood cell distribution width-to-albumin ratio andFrontiers in nutrition · 2026Article
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Authors and funding
7 authors.
Funding
Abstract
purposeThis 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.
methodsPatients 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).
resultsA 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).
conclusionElevated 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.
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