AccScience Publishing / OTE / Volume 1 / Issue 1 / DOI: 10.36922/ote.7109
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ORIGINAL RESEARCH ARTICLE

Hemoglobin-to-red blood cell distribution width ratio as a predictor of cardiovascular and all-cause mortality in osteoarthritis patients

Jinfeng Wen1† ,  Ying Yang2† ,  Pengcheng Gao1† ,  Song Liu2 ,  Qizhang Man3 ,  Yifeng Huang3 ,  Lei Fan4* ,  Li Tao4* ,  Xie Hao4*
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1 School of Laboratory Medicine and Biotechnology, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
2 The First School of Clinical Medicine, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
3 School of Stomatology, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
4 Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Baiyun District, Guangzhou, Guangdong, China
†These authors contributed equally to this work.
OTE 2025, 1(1), 7109 https://doi.org/10.36922/ote.7109
Received: 8 December 2024 | Revised: 22 January 2025 | Accepted: 11 February 2025 | Published online: 28 February 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

The hemoglobin-to-red blood cell distribution width ratio (HRR) has been shown to predict outcomes in both cancer and cardiovascular disease (CVD). However, its potential in forecasting mortality rates for osteoarthritis (OA) remains uninvestigated. This study examines the association between HRR and mortality in American OA patients. A prospective cohort study of 3,087 OA patients from the National Health and Nutrition Examination Survey (2001 – 2016) tracked mortality using National Death Index records until 2018. Cox proportional hazards models and Restricted Cubic Spline analysis were utilized to assess the relationship between HRR and mortality from all causes, CVD, and cancer. Receiver operating characteristic (ROC) curves, sensitivity analyses, and stratified analyses identified high-risk individuals and validated the findings. Over 82,097 person-years, 777 deaths were recorded, including 270 from CVD and 141 from cancer. The median HRR was 1.06. Lower HRR values were associated with higher risks of all-cause and CVD mortality in OA patients, even after adjusting for confounding factors. An L-shaped relationship was observed, with mortality rates stabilizing at HRR values of 1.10 for all-cause and 1.083 for CVD. ROC analysis showed that HRR’s area under the curve for predicting mortality was 0.81 for all-cause and 0.80 for CVD. Findings were consistent across analyses. HRR showed L-shaped links to CVD and all-cause mortality in OA patients, with CVD threshold at 1.083 and all-cause at 1.10. HRR is a reliable predictor of mortality in this population, warranting further investigation in large clinical trials.

Keywords
Osteoarthritis
Hemoglobin-to-red blood cell distribution width ratio
Mortality
Cardiovascular diseases
National Health and Nutrition Examination Survey
Funding
None.
Conflict of interest
Lei Fan is an Editorial Board Member of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly.
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