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

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

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