# Predictive value of red cell distribution width to albumin ratio for acute kidney injury in patients with acute pancreatitis

## TL;DR

This study finds that a high red cell distribution width to albumin ratio is linked to increased risk of kidney injury in patients with acute pancreatitis.

## Contribution

The novel contribution is identifying RAR as an independent risk factor for acute kidney injury in acute pancreatitis patients.

## Key findings

- High RAR is independently associated with acute kidney injury in acute pancreatitis patients.
- A 1.46-fold increased risk of AKI is observed per unit increase in RAR.
- The relationship between RAR and AKI is linear according to restricted cubic spline analysis.

## Abstract

Red blood cell volume distribution width (RDW) and albumin have been increasingly recognized for their roles in inflammatory diseases. However, the relationship between RDW-to-albumin ratio (RAR) and acute kidney injury (AKI) in acute pancreatitis (AP) patients has not been clarified. Therefore, the research aims to explore the correlation between RAR and AKI risk in critically ill patients with AP.

Patients diagnosed with AP from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included in this retrospective study. The primary outcome measure was the incidence of AKI. Logistic regression analysis and restricted cubic spline were used to evaluate the relationship between RAR and AKI incidence in AP patients. Subgroup analyses were used to test interactions.

In total, 600 patients were enrolled in the study. The incidence of AKI was 77.3%. Based on multiple logistic regression analysis, RAR exhibited a positive association with AKI incidence as either a continuous (OR 1.46, 95% CI 1.22–1.76, P < 0.05) or categorical variable (OR 2.79, 95% CI 1.69–4.59, P < 0.05). The restricted cubic splines model illustrated the linear relationship between higher RAR and increased risk of AKI in AP patients.

High RAR is an independent risk factor for AKI in critically ill patients with AP. Early assessment of RAR may facilitate risk stratification to guide clinical management, thereby improving clinical outcomes.