Association between the red blood cell distribution width to albumin ratio and cardiovascular outcomes in MASLD patients: a national cohort study integrating machine learning
- 1Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
Abstract
Background: The red blood cell distribution width to albumin ratio (RAR) is a novel biomarker reflecting systemic inflammation and metabolic status. This study investigated the association between RAR and cardiovascular outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: This cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES). MASLD participants were categorized by RAR levels. Regression models and restricted cubic splines (RCS) assessed the relationships of RAR with life’s crucial 9 (LC9), cardiovascular disease (CVD), all-cause mortality, and cardiovascular mortality.
Results: A total of 4,419 participants with MASLD were included in our study. Multivariable analysis showed higher RAR was significantly associated with lower LC9 (β = − 3.59, 95% CI: − 4.46 to − 2.73) and with higher odds of prevalent CVD (OR = 1.88, 95% CI: 1.34 to 2.64). Cox regression analysis revealed significant positive associations between RAR and all-cause mortality (HR = 2.13, 95% CI: 1.69 to 2.69) as well as cardiovascular mortality (HR = 3.05, 95% CI: 1.71 to 5.42). Nonlinear relationships were identified between RAR and cardiovascular outcomes. Machine learning revealed RAR as a key determinant of cardiovascular risk in MASLD patients.
Conclusion: RAR is a simple and reliable indicator associated with adverse cardiovascular outcomes in MASLD patients.
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BibTeX
@article{tang2026association,
title = {{Association between the red blood cell distribution width to albumin ratio and cardiovascular outcomes in MASLD patients: a national cohort study integrating machine learning}},
author = {Xiao-Xuan Tang and Meng-Xi Li and Yu-Jia Gao and Yi-Ran Liu and Chong Liu and Bin Zhang},
journal = {BMC Cardiovascular Disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06396-2},
url = {https://doi.org/10.1186/s12872-026-06396-2},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Association between the red blood cell distribution width to albumin ratio and cardiovascular outcomes in MASLD patients: a national cohort study integrating machine learning
AU - Xiao-Xuan Tang
AU - Meng-Xi Li
AU - Yu-Jia Gao
AU - Yi-Ran Liu
AU - Chong Liu
AU - Bin Zhang
PY - 2026
DA - 2026/08/07
JO - BMC Cardiovascular Disorders
DO - 10.1186/s12872-026-06396-2
UR - https://doi.org/10.1186/s12872-026-06396-2
AB - Background: The red blood cell distribution width to albumin ratio (RAR) is a novel biomarker reflecting systemic inflammation and metabolic status. This study investigated the association between RAR and cardiovascular outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES). MASLD participants were categorized by RAR levels. Regression models and restricted cubic splines (RCS) assessed the relationships of RAR with life’s crucial 9 (LC9), cardiovascular disease (CVD), all-cause mortality, and cardiovascular mortality. Results: A total of 4,419 participants with MASLD were included in our study. Multivariable analysis showed higher RAR was significantly associated with lower LC9 (β = − 3.59, 95% CI: − 4.46 to − 2.73) and with higher odds of prevalent CVD (OR = 1.88, 95% CI: 1.34 to 2.64). Cox regression analysis revealed significant positive associations between RAR and all-cause mortality (HR = 2.13, 95% CI: 1.69 to 2.69) as well as cardiovascular mortality (HR = 3.05, 95% CI: 1.71 to 5.42). Nonlinear relationships were identified between RAR and cardiovascular outcomes. Machine learning revealed RAR as a key determinant of cardiovascular risk in MASLD patients. Conclusion: RAR is a simple and reliable indicator associated with adverse cardiovascular outcomes in MASLD patients.
SN - 1471-2261
ER -