{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:06:30Z","timestamp":1774627590966,"version":"3.50.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to explore the relationship between the blood cell distribution width-to-albumin ratio (RAR) and in-hospital mortality in patients with congestive heart failure (CHF) combined with chronic kidney disease (CKD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The patients' information was collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The association of the RAR and in-hospital mortality were assessed via logistic regression analysis with adjusting for different covariate, followed by visualization via the restricted cubic splines (RCS) analysis. Correlation analysis and machine learning algorithms were used to screen the clinical features associated with RAR. Mediation analysis was used to explore the function of RAR-related feature on their association. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) curves were used to explore the efficacy of RAR in predicting patient outcomes and the net clinical benefit, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,243 patients were included in this study. Logistic regression analysis showed that RAR was a risk factor of in-hospital death. RCS showed a linear relationship between RAR and in-hospital mortality, which was not affected by confounding factors. Monocytes played a mediating role in the relationship between RAR and in-hospital mortality. RAR had a good efficacy and clinical net for predicting in-hospital mortality, half-year mortality, one-year mortality, and three-year mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found that RAR was a risk factor for in-hospital death and could predict short-term and long-term outcomes in patients with CHF combined with CKD. Monocytes played a mediating role in their relationship.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1563512","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T05:25:59Z","timestamp":1751606759000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between red blood cell distribution width-to-albumin ratio and in-hospital mortality in patients with congestive heart failure combined with chronic kidney 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