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Published on: November 8, 2017
Red Blood Cell Distribution Width-to-Albumin Ratio as a Predictor of 28-Day Mortality in Patients with Traumatic
Ting Pan1,2, Wei Sun1, Qihui Huang1
1Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Objective:
Traumatic brain injury (TBI) remains one of the leading causes of mortality and disability worldwide. Early identification of high‑risk patients is essential for improving clinical outcomes. The red blood cell distribution width‑to‑albumin ratio (RAR) has emerged as a novel biomarker integrating systemic inflammation and nutritional status. This study aimed to evaluate the prognostic value of RAR for predicting 28‑day mortality in critically ill patients with TBI.
Methods:
This retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult TBI patients admitted to the intensive care unit (ICU) were included. RAR was calculated based on red blood cell distribution width (RDW) and serum albumin levels measured within the first 24 hours of ICU admission. The primary endpoint was 28-day all-cause mortality. Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) analysis, and subgroup analyses were performed. Furthermore, 1:1 propensity score matching (PSM) was conducted to minimize potential confounding bias and validate the robustness of the prognostic association.
Results:
A total of 465 TBI patients were included, among whom 83 (17.8%) died within 28 days of ICU admission. RAR levels were significantly higher in non-survivors compared to survivors (4.18±0.48 vs 3.56±0.44, p < 0.001). Kaplan-Meier analysis indicated a significantly higher mortality rate in the high RAR group (Log-rank test p < 0.001). Cox regression analysis showed that after adjusting for confounding factors, a high RAR level was an independent risk factor for 28-day mortality in TBI patients (HR = 1.840, 95% CI 1.053-3.214, p = 0.032). This association remained robust in the PSM cohort (HR = 2.928, 95% CI: 1.456-5.886, p = 0.003). RCS analysis demonstrated an increasing hazard ratio trend as RAR rose, plateauing after a threshold of 3.579. Subgroup analysis suggested that the predictive value of RAR was more pronounced in patients with lower disease severity (SOFA score <5).
Conclusion:
RAR is an independent predictor of 28-day mortality in critically ill patients with TBI. As a simple, inexpensive, and readily available biomarker integrating inflammatory and nutritional status, RAR may serve as a useful tool for early risk stratification in patients with TBI.
