ArticleFrontiers in nutrition2026
Prognostic value of albumin-related inflammatory ratios for 30-day mortality in rheumatic heart disease: a dual-cohort study with external 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. Not yet cited in PubMed.
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Abstract
Background: Rheumatic heart disease (RHD) is a chronic valvular condition characterized by persistent autoimmune inflammation and nutritional deficiencies. Albumin not only reflects the body's nutritional status but also eliminates pro-inflammatory stimuli and mitigates inflammatory responses. This study aimed to evaluate the prognostic value of novel albumin-related inflammatory biomarkers for short-term mortality in patients with RHD. Methods: This retrospective dual-cohort study included 496 RHD patients from the MIMIC-IV database and 268 patients from Shaanxi Provincial People's Hospital. The primary outcome was all-cause mortality within 30 days. Cox proportional hazards regression, restricted cubic spline analysis, time-dependent ROC curves, and integrated discrimination improvement (IDI) were performed to assess the independent associations, dose-response relationships, discriminative ability, and incremental predictive value of each biomarker. Results: RAR consistently demonstrated the strongest association with 30-day mortality across both cohorts. In fully adjusted Cox models, RAR remained significantly associated with mortality (MIMIC: HR 4.12, 95% CI 1.79-9.49; external validation: HR 3.20, 95% CI 1.25-8.23). RAR also showed significant positive linear dose-response relationships, achieved the highest time-dependent AUC, and provided significant incremental predictive value beyond SOFA, SAPS II, and OASIS in both cohorts (all IDI Conclusion: RAR has been confirmed as the most reliable indicator for predicting 30-day mortality in RHD patients. It offers a simple, cost-effective tool for early risk stratification, particularly in resource-limited settings where RHD burden remains highest.
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