Association Between Red Cell Distribution Width-to-Albumin Ratio and Sepsis-Associated Acute Kidney Injury

Background Sepsis constitutes a critical syndrome frequently observed in ICUs, posing a major worldwide health challenge.Recent data indicate that roughly one fifth of non-critical sepsis patients develop AKI, with its frequency continuing to rise.Although the erythrocyte distribution width–albumin ratio (RA) has emerged as a new indicator, its role in forecasting SA-AKI is still poorly characterized.Accordingly, we sought to determine whether RA independently predicts the onset of SA-AKI. Methods A retrospective cohort of 133 sepsis patients admitted to our ICU between September 2019 and September 2021 was analyzed.Using KDIGO 2012 guidelines, participants were classified into AKI and non-AKI cohorts based on the emergence of AKI within 28 days of ICU entry. The predictive value of RA for SA-AKI was assessed by univariate and multivariate logistic regression analysis.Subgroup analyses stratified by sex, age, APACHE II score, comorbidities, mechanical ventilation, and whether vasoactive drugs were applied. Results Of the 133 included sepsis cases, 56 (42.1%) experienced AKI during ICU stay.Intergroup comparisons revealed marked discrepancies in RA, PCT, Lac, RDW, MPV, APACHE II scores, and rates of mechanical ventilation or vasopressor use (all P < 0.05). After multivariable adjustment, RA remained independently associated with AKI (OR 1.53; 95% CI 1.06–2.21; P = 0.023). Subgroup analyses confirmed the robustness of this association across diverse clinical strata. Conclusion Elevated RA independently forecasts SA-AKI, underscoring its utility as a readily available early warning index in septic individuals.