ArticleFrontiers in nutrition2026
Red cell distribution width-to-albumin ratio as a potential biomarker for short-term mortality risk in critically ill patients with cerebral hemorrhage: a retrospective study with dual-cohort validation.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
Background: The red cell distribution width-to-albumin ratio (RAR) is a composite biomarker integrating inflammatory, nutritional, and stress status; however, its association with short-term prognosis in patients with intracerebral hemorrhage (ICH) remains unclear. Methods: This study was a retrospective dual-cohort study. A total of 2,327 ICH patients from the MIMIC-IV database were included as the derivation cohort, and 428 patients from a tertiary hospital were collected as the external validation cohort. The association between RAR and outcomes was analyzed using multivariable Cox regression, with restricted cubic splines employed to examine non-linear relationships. Multiple machine learning algorithms were utilized to screen key prognostic variables, and a logistic regression-based risk prediction model was constructed. Its discriminative ability and stability were validated in both internal and external cohorts. Results: After adjusting for multiple confounders, including demographic characteristics, comorbidities, disease severity, and treatment measures, a higher RAR level remained an independent risk factor for 28-day ICU mortality (adjusted HR = 1.17, 95% CI: 1.08-1.27) and 28-day in-hospital all-cause mortality (adjusted HR = 1.14, 95% CI: 1.05-1.23) in ICH patients. Restricted cubic spline analysis further indicated a significant non-linear dose-response relationship between RAR and these outcomes ( Conclusion: RAR is an independent predictor of short-term mortality risk in patients with ICH. The prediction model incorporating RAR exhibits good discriminative ability and cross-cohort stability, offering a practical tool for early identification of high-risk patients and optimization of management strategies. However, this study has certain limitations, including its retrospective design, limited sample size and single-center source for external validation, and lack of neuroimaging data (e.g., hematoma location/volume). Future prospective multi-center studies are needed to further validate its clinical value.
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