■红细胞功能障碍是糖尿病(DM)的特征。然而,红细胞相关生物标志物不能充分解释DM的高患病率。这里,我们将红细胞分布宽度与白蛋白比值(RAR)描述为一种新型炎症生物标志物,用于评估与DM患病率和全因死亡率预后的相关性.
■本研究中分析的数据来自1999-2020年的国家健康和营养检查调查(NHANES)。共有40,558名参与者(非DM和DM)参加了研究;RAR四分位数校准为Q1[2.02,2.82]mL/g,Q2(2.82,3.05]mL/g,Q3(3.05,3.38]mL/g,和Q4(3.38,12.08]mL/g。共随访了8,482名DM患者(中位数为84个月),其中2411人死亡,6071人幸存。分析与RAR和DM相关的患病率和预后;年龄和性别分层分析RAR在DM中的患病率和长期预后的敏感性。
■在非DM(n=30,404)和DM(n=10,154)志愿者中,RAR四分位数的DM患病率为8.23%,15.20%,23.92%,和36.39%。关于DM,RAR的多变量优势比(OR)是显著的,1.68(95%CI1.42,1.98)。以Q1为基础,Q4OR为2.57(95%CI2.11,3.13)。死亡(n=2,411)和存活(n=6,071)DM患者的DM发病率百分比在RAR四分位数之间变化。具体来说,RAR四分位数死亡率为20.31%,24.24%,22.65%,29.99%(P<0.0001)。RAR的多变量风险比(HR)为1.80(95%CI1.57,2.05)。以Q1为基础,校正混杂因素后,第四季度HR为2.59(95%CI2.18,3.09).敏感性分析显示男性DM患者的HR为2.27(95%CI1.95,2.64),高于女性1.56(95%CI1.31,1.85)。与60岁以上的DM患者相比,60岁或以下的DM患者的HR为2.08(95%CI1.61,2.70)。HR为1.69(95%CI1.47,1.94)。DM患者RAR的HR通过受限三次样条(RCS)模型进行优化;3.22被确定为逆L曲线的拐点。与RAR≤3.22mL/g的DM患者相比,RAR>3.22mL/g的DM患者的生存期更短,死亡率更高。OR和HRRAR值均远高于常规红细胞分布宽度。
■对于预测DM患病率,RAR的预测值比RDW的预测值更准确,而RAR,DM危险因素,对病情有长期预测能力。在女性DM患者中,年龄≤60岁的患者的生存时间随着RAR的增加而减少。
UNASSIGNED: Erythrocyte dysfunction is a characteristic of diabetes mellitus (DM). However, erythrocyte-associated biomarkers do not adequately explain the high prevalence of DM. Here, we describe red blood cell distribution width to albumin ratio (RAR) as a novel inflammatory biomarker for evaluating an association with DM prevalence and prognosis of all-cause mortality.
UNASSIGNED: Data analyzed in this study were extracted from the National Health and Nutrition Examination Survey (NHANES) 1999-2020. A total of 40,558 participants (non-DM and DM) were enrolled in the study; RAR quartiles were calibrated at Q1 [2.02,2.82] mL/g, Q2 (2.82,3.05] mL/g, Q3 (3.05,3.38] mL/g, and Q4 (3.38,12.08] mL/g. A total of 8,482 DM patients were followed (for a median of 84 months), of whom 2,411 died and 6,071 survived. The prevalence and prognosis associated with RAR and DM were analyzed; age and sex were stratified to analyze the prevalence of RAR in DM and the sensitivity of long-term prognosis.
UNASSIGNED: Among non-DM (n=30,404) and DM (n=10,154) volunteers, DM prevalence in RAR quartiles was 8.23%, 15.20%, 23.92%, and 36.39%. The multivariable odds ratio (OR) was significant for RAR regarding DM, at 1.68 (95% CI 1.42, 1.98). Considering Q1 as a foundation, the Q4 OR was 2.57 (95% CI 2.11, 3.13). The percentages of DM morbidity varied across RAR quartiles for dead (n=2,411) and surviving (n=6,071) DM patients. Specifically, RAR quartile mortality ratios were 20.31%, 24.24%, 22.65%, and 29.99% (P<0.0001). The multivariable hazard ratio (HR) for RAR was 1.80 (95% CI 1.57, 2.05). Considering Q1 as a foundation, the Q4 HR was 2.59 (95% CI 2.18, 3.09) after adjusting for confounding factors. Sensitivity analysis revealed the HR of male DM patients to be 2.27 (95% CI 1.95, 2.64), higher than females 1.56 (95% CI 1.31, 1.85). DM patients who were 60 years of age or younger had a higher HR of 2.08 (95% CI1.61, 2.70) as compared to those older than 60 years, who had an HR of 1.69 (95% CI 1.47, 1.94). The HR of RAR in DM patients was optimized by a restricted cubic spline (RCS) model; 3.22 was determined to be the inflection point of an inverse L-curve. DM patients with a RAR >3.22 mL/g suffered shorter survival and higher mortality as compared to those with RAR ≤3.22 mL/g. OR and HR RAR values were much higher than those of regular red blood cell distribution width.
UNASSIGNED: The predictive value of RAR is more accurate than that of RDW for projecting DM prevalence, while RAR, a DM risk factor, has long-term prognostic power for the condition. Survival time was found to be reduced as RAR increased for those aged ≤60 years among female DM patients.