Association Between the Red Cell Distribution Width-to-Albumin Ratio and Pediatric Community-Acquired Pneumonia
1Department of Pediatrics, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
Insights
The red cell distribution width-to-albumin ratio (RAR) shows strong prognostic value in pediatric community-acquired pneumonia (CAP). This simple biomarker effectively predicts severe outcomes, aiding in risk stratification for children with CAP.
Area of Science:
- Pediatric Medicine
- Clinical Biochemistry
- Pulmonology
Background:
- The prognostic significance of the red cell distribution width-to-albumin ratio (RAR) is established in adult diseases.
- Limited data exists on the role of RAR in pediatric community-acquired pneumonia (CAP).
Purpose of the Study:
- To investigate the association between RAR and pediatric CAP.
- To evaluate RAR's ability to predict clinical outcomes in children with CAP using routine laboratory parameters.
Main Methods:
- Retrospective analysis of 1151 children hospitalized with pneumonia (2013-2024).
- Calculation of RAR-CV (RDW-CV/albumin) and RAR-SD (RDW-SD/albumin).
Main Results:
- RAR values significantly correlated with all adverse outcomes.
- RAR demonstrated superior predictive ability (AUC) for PICU admission, IMV, and vasopressor use compared to RDW or albumin alone.
- RAR-SD showed strong predictive performance for mortality (AUC=0.809).
Conclusions:
- This is the first study evaluating RAR's prognostic value in pediatric CAP.
- RAR is strongly associated with adverse clinical outcomes in children with CAP.
- RAR serves as a simple, cost-effective biomarker for risk stratification and prognostication in pediatric CAP.
Background:
Although the prognostic value of the red cell distribution width-to-albumin ratio (RAR) has been well demonstrated in adult diseases, there is a lack of data regarding its role in pediatric community-acquired pneumonia (CAP). We aimed to investigate the association between RAR and pediatric CAP and to evaluate its ability to predict clinical outcomes using routinely available laboratory parameters.
Methods:
We retrospectively included 1151 children hospitalized with pneumonia between 2013 and 2024. RAR-CV was calculated by dividing red cell distribution width-coefficient of variation (RDW-CV) by albumin concentration, and RAR-SD by dividing red cell distribution width-standard deviation (RDW-SD) by albumin.
Results:
RAR values were significantly associated with all outcomes. The area under the curve (AUC) values of RAR for predicting pediatric intensive care unit (PICU) admission, invasive mechanical ventilation (IMV), and vasopressor use were higher than those of its individual components (RDW and albumin). In ROC analyses including all clinical parameters, no variable outperformed RAR in predicting these outcomes. RAR significantly predicted PICU admission, IMV, vasopressor use, and mortality (p < 0.001), and RAR-SD showed good predictive performance for mortality (AUC = 0.809).
Conclusions:
To our knowledge, this is the first study to evaluate the prognostic value of RAR in pediatric CAP. Our findings demonstrate a strong association between RAR levels and adverse clinical outcomes. Given its simplicity, cost, and availability, RAR may serve as a valuable biomarker to support risk stratification and prognostication in children with CAP.
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