红细胞分布宽度-白蛋白比值与接受静脉-动脉体外膜肺氧合支持的急性暴发性心肌炎患儿院内死亡风险的关联性研究OA北大核心CSTPCD

Objective To investigate the association between red cell distribution width to albumin ratio(RAR)and the risk of in-hospital mortality in pediatric patients with acute fulminant myocarditis(AFM)receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)support.Methods A total of 125 pediatric patients receiving VA-ECMO support for AFM at the Seventh Medical Center of Chinese PLA General Hospital and six other ECMO centers across China from July 2015 to August 2022 were selected.The optimal cut-off value of RAR was determined based on the receiver operating characteristic(ROC)curve,and the patients were divided into RAR＜0.38 and RAR 0.38 groups.Binary logistic regression analysis was used to assess the association between RAR and the in-hospital mortality.Results A total of 36(28.8％)pediatric patients experienced in-hospital death during the study period.After correcting for potential confounders,per 1 standard deviation(SD)increase in RAR was associated with a 93％increase in the risk of in-hospital mortality(OR=1.93,95％CI:1.1-3.39,P=0.022).Compared with the RAR＜0.38 group,the RAR ≥0.38 group had a 6.5-fold increase in-hospital mortality(OR=7.5,95％CI:1.85-30.32,P=0.005).Restricted cubic splines(RCS)analysis showed a positive linear relationship between RAR and the risk of in-hospital mortality(Pnonlinear=0.325).Subgroup analysis revealed an interaction between gender and RAR on the in-hospital mortality in pediatric patients with AFM receiving VA-ECMO.Conclusions Elevated RAR is associated with a high risk of in-hospital mortality in pediatric patients with AFM receiving VA-ECMO support,indicating RAR may serve as a novel molecular biomarker to assess clinical prognosis.