血红蛋白与红细胞分布宽度比（HRR）是肿瘤预后评估中的一种新的炎症标志物。然而，它在心血管领域的研究还相对有限，特别是关于其与利尿反应和临床结局的相关性。本研究是对肾脏优化策略评估（ROSE AHF）临床试验的二次分析。感兴趣的结果包括全因死亡、再次住院和利尿反应。分别进行了多变量Cox比例风险回归和线性回归模型分析。进一步在射血分数（射血分数≥50%为保留型，＜50%为降低型）亚组中评估了预后结果和利尿反应。共纳入了351例患者，并根据入院时的HRR中位数值（0.7131）进行进一步分类：低HRR组（n=176）和高HRR组（n=175）。发现高HRR独立与降低全因死亡风险（风险比=0.51；95%可信区间，0.30-0.87；P=0.013）、减少全因死亡或再次住院风险（风险比=0.62；95%可信区间，0.39-0.98；P=0.039）相关。此外，高HRR提示较低的尿液累积排出量（OR：-992.33，P=0.004）和较少的体重减轻（OR：3.08，P<0.001）在利尿后的72小时内。亚组分析显示EF和HRR在预后影响或利尿反应方面无显著的交互作用，并且HRR与血浆容积呈负相关。高HRR表明AHF患者发展不良临床结局的风险较低，而利尿反应较差，可能是因为体液过多。© 2023 Elsevier Ireland Ltd. 保留所有权利。

Hemoglobin to Red Cell Distribution Width Ratio (HRR) is a novel inflammatory marker in the prognostic assessment of tumors. Nevertheless, its focus on the cardiovascular field is relatively limited, particularly regarding its correlation with diuretic responses and clinical outcomes.This is a secondary analysis of the Renal Optimization Strategies Evaluation (ROSE AHF) clinical trial. The outcomes of interest included all-cause death, rehospitalization and diuretic responses. Multivariable Cox proportional hazard regression and linear regression models were performed, respectively. Prognostic outcomes and diuretic response were further evaluated in ejection fraction (EF) subgroups (preserved EF ≥ 50% and reduced EF<50%).A total of 351 patients were included in the present study and further categorized according to HRR median (0.7131) value at admission: low HRR group (n = 176) and high HRR group (n = 175). High HRR were found to be independently associated with decreased risk of all-cause death (HR = 0.51; 95% CI,0.30-0.87, P = 0.013), reduced risk of developing all-caused death or rehospitalization (HR = 0.62; 95% CI,0.39-0.98, P = 0.039). Furthermore, high HRR indicated lower cumulative urine output (OR: -992.33, P = 0.004) and less weight loss (OR: 3.08, P < 0.001) within 72 h after diuresis. Subgroup analysis revealed no significant interaction effect between EF and HRR in prognostic impact or diuretic responses, and HRR was negatively correlated with plasma volume.High HRR demonstrated a lower risk of developing adverse clinical outcomes and a poorer diuretic response that might be due to less volume overload in AHF patients.Copyright © 2023 Elsevier Ireland Ltd. All rights reserved.