Skip to content
DraconiticResearch
Search Sources API
178,033 studies31 sourcesUpdated 3 min ago
Peer-reviewedCC BY 4.0Scientific Reports

Longitudinal red blood cell distribution width-to-albumin ratio trajectories are associated with 28-day mortality in sepsis-associated acute kidney injury

  • Xin Hu
  • Ping Wang
  • Kangxing Wang
  • Yugang Zou
Open at sourcePDFDOICite

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.

Related

  1. The red blood cell distribution width-to-albumin ratio and 28-day mortality in patients with severe cardiogenic shock: a retrospective cohort study based on MIMIC-IV with single-center external validation
    Yi Ou, Xiongwei Meng, Dan Zhang +3
    Frontiers in medicinePeer-reviewedCC BYFull textGeneral medicineEurope PMC
  2. Longitudinal serum albumin trajectories and neurological outcomes after aneurysmal subarachnoid hemorrhage
    Hua Tang, Yanli Tang, Siqi Wu +2
    Frontiers in nutritionPeer-reviewedCC BYFull textNeurologyEurope PMCPMC
  3. Elevated Maternal Glycated Albumin is Associated with Large for Gestational Age Infants: Results from a Prospective Longitudinal Study
    C. Ferreira Jorgensen, T. S. Chillon, C. Scavenius +13
    medRxivPreprintAll rights reservedFull textEndocrinology & metabolismmedRxiv
  4. Correlation of red cell distribution width-to-albumin ratio combined with SOFA score with 28-day all-cause mortality in patients with acute pancreatitis: A retrospective study based on the MIMIC-IV database
    Jianlei Chen, Hua Li, Hongfei Wang +8
    PLOS OnePeer-reviewedCC BY 4.0Full textCell biologyCardiovascular medicinePLOS
  5. Joint trajectories and associated characteristics of postpartum depressive and anxiety symptoms: a longitudinal study
    Jinyi Li, Shiying Wang, Yulian Liang +6
    BMC Public HealthPeer-reviewedCC BY-NC-ND 4.0Epidemiology & public healthCrossref

Cite

BibTeXRIS
BibTeX
@article{hu2026longitudinal,
  title = {{Longitudinal red blood cell distribution width-to-albumin ratio trajectories are associated with 28-day mortality in sepsis-associated acute kidney injury}},
  author = {Xin Hu and Ping Wang and Kangxing Wang and Yugang Zou},
  journal = {Scientific Reports},
  year = {2026},
  month = oct,
  doi = {10.1038/s41598-026-69565-5},
  url = {https://www.nature.com/articles/s41598-026-69565-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Longitudinal red blood cell distribution width-to-albumin ratio trajectories are associated with 28-day mortality in sepsis-associated acute kidney injury
AU  - Xin Hu
AU  - Ping Wang
AU  - Kangxing Wang
AU  - Yugang Zou
PY  - 2026
DA  - 2026/10/02
JO  - Scientific Reports
DO  - 10.1038/s41598-026-69565-5
UR  - https://www.nature.com/articles/s41598-026-69565-5
AB  - 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.
SN  - 2045-2322
ER  -