Front Endocrinol (Lausanne). 2026 Mar 30;17:1778191. doi: 10.3389/fendo.2026.1778191. eCollection 2026.
ABSTRACT
OBJECTIVE: This study aimed to assess the relationship between admission hemoglobin-to-red blood cell distribution width ratio (HRR) and stroke-associated pneumonia (SAP) risk in patients with acute ischemic stroke (AIS), and to explore whether this association is modified by diabetes status.
METHODS: In this retrospective study of 1051 patients with AIS admitted within 72 hours of symptom onset, we first visualized the shape of the association between admission HRR and SAP risk using a generalized additive model (GAM). Subsequently, multivariable logistic regression was used to assess this association, adjusting for available confounders, yielding adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The stability of this association was rigorously tested through extensive subgroup and sensitivity analyses.
RESULTS: A linear negative association was observed between HRR and SAP risk. In the fully adjusted model, HRR was inversely associated with SAP risk (adjusted OR = 0.75; 95% CI: 0.64, 0.87; p < 0.001). A significant interaction was detected between HRR and diabetes status (p for interaction = 0.01). Stratified analysis showed that the inverse association was present in non-diabetic patients (OR = 0.69; 95% CI: 0.59, 0.81; p < 0.001) but not in diabetic patients (OR = 0.97; 95% CI: 0.77, 1.21; p = 0.76).
CONCLUSION: Admission HRR is inversely associated with SAP risk in AIS patients. This association is modified by diabetes status (p for interaction = 0.01), with the inverse association attenuated in diabetic patients. SAP risk stratification strategies may need to account for diabetes status.
PMID:41982774 | PMC:PMC13070766 | DOI:10.3389/fendo.2026.1778191