{
  "abstract": "Sepsis-associated acute kidney injury (SAAKI) involves rapidly evolving inflammatory and nutritional disturbances, yet most prognostic studies rely on single baseline biomarkers. We examined whether longitudinal red blood cell distribution width-to-albumin ratio (RAR) trajectories identify reproducible mortality-risk phenotypes. This multicenter retrospective study included MIMIC-IV v3.1 as the development cohort ( n = 4,273), MIMIC-III CareVue as temporal validation ( n = 1,287), and eICU-CRD v2.0 as external validation ( n = 3,195). Group-based trajectory modeling characterized 14-day RAR patterns. Multivariable Cox models evaluated 28-day all-cause mortality. Six machine-learning models predicted the highest-risk trajectory using first-24-h variables, with SHAP used for interpretation. Four trajectories were identified: Persistently Low, Moderate-Stable, Moderate-Elevated, and Persistently High. Mortality increased from 17.54% in Persistently Low to 38.48% in Persistently High. Compared with Persistently Low, Persistently High was associated with higher adjusted mortality in MIMIC-IV (HR 2.22, 95% CI 1.79–2.74), MIMIC-III CareVue (HR 3.32, 95% CI 2.31–4.78), and eICU-CRD (HR 1.71, 95% CI 1.40–2.07). XGBoost achieved AUCs of 0.895, 0.918, and 0.904, respectively. SHAP highlighted baseline RAR, lactate, other infection source, albumin, and creatinine. Longitudinal RAR trajectories identify reproducible mortality-risk phenotypes across the three cohorts and may support early risk stratification, although prospective validation is required.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "Xin Hu"
    },
    {
      "name": "Ping Wang"
    },
    {
      "name": "Kangxing Wang"
    },
    {
      "name": "Yugang Zou"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0g7cc6thc6as5.bib",
  "cited_by": 0,
  "doi": "10.1038/s41598-026-69565-5",
  "fulltext_url": null,
  "id": "0g7cc6thc6as5",
  "issns": [
    "2045-2322"
  ],
  "landing_url": "https://www.nature.com/articles/s41598-026-69565-5",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2727|Acute Kidney Injury Research"
    ]
  ],
  "openalex": "W7215098391",
  "pdf_url": "https://www.nature.com/articles/s41598-026-69565-5.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/0g7cc6thc6as5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:19Z",
      "native_id": "10.1038/s41598-026-69565-5",
      "source": "crossref",
      "url": "https://www.nature.com/articles/s41598-026-69565-5"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Acute Kidney Injury Research",
      "subfield": "general"
    }
  ],
  "title": "Longitudinal red blood cell distribution width-to-albumin ratio trajectories are associated with 28-day mortality in sepsis-associated acute kidney injury",
  "title_text": "Longitudinal red blood cell distribution width-to-albumin ratio trajectories are associated with 28-day mortality in sepsis-associated acute kidney injury",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:19Z",
  "url": "https://research.draconitic.com/paper/0g7cc6thc6as5",
  "venue": "Scientific Reports",
  "versions": []
}