Prognostic value of albumin-related inflammatory ratios for 30-day mortality in rheumatic heart disease: a dual-cohort study with external v

\nRheumatic heart disease is a chronic valvular condition characterized by persistent autoimmune inflammation and nutritional deficiencies. Albumin not only reflects the body’s nutritional status but also eliminates pro-inflammatory stimuli and mitigates inflammatory responses.\n\nThis study aimed to evaluate the prognostic value of novel albumin-related inflammatory biomarkers for short-term mortality in patients with RHD.\n\nA dual-cohort study was conducted, including 496 RHD patients from the MIMIC-IV database and 268 patients from Shaanxi Provincial People’s Hospital. The primary outcome was all-cause mortality within 30 days.\n\nCox proportional hazards regression, restricted cubic spline analysis, time-dependent ROC curves, and integrated discrimination improvement (IDI) were performed to assess the independent associations, dose–response relationships, discriminative ability, and incremental predictive value of each biomarker.\n\nResults showed that the albumin-related inflammatory ratio (RAR) consistently demonstrated the strongest association with 30-day mortality across both cohorts.\n\nIn fully adjusted Cox models, RAR remained significantly associated with mortality (MIMIC: HR 4.12, 95% CI 1.79–9.49; external validation: HR 3.20, 95% CI 1.25–8.23).\n\nRAR also showed significant positive linear dose–response relationships, achieved the highest time-dependent AUC, and provided significant incremental predictive value beyond SOFA, SAPS II, and OASIS in both cohorts (all IDI p \n\nHowever, the results should be interpreted with caution due to the study's limitations, including the reliance on pre-existing data and the potential for confounding variables.\n\nIn conclusion, this study provides evidence for the prognostic value of albumin-related inflammatory ratios in patients with rheumatic heart disease, highlighting the potential for novel biomarkers to improve mortality risk prediction.\n\nThe findings of this study should not be translated into clinical practice without further validation and consideration of individual patient factors.\n\nFurthermore, the results of this study may have implications for the development of personalized medicine approaches in patients with RHD.