Association Between Red Blood Cell Distribution Width–Albumin Ratio and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Study

Abstract

Purpose High levels of red blood cell distribution width (RDW) and hypoalbuminemia are markers of poor prognosis in chronic obstructive pulmonary disease (COPD) patients. However, few studies have shown that the red blood cell distribution width–albumin ratio (RAR) is related to the mortality of COPD. This study aimed to explore the relationship between RAR and hospital mortality in COPD patients admitted to the intensive care unit (ICU). Patients and Methods Patients were retrospectively incorporated from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and divided into two groups by a cutoff value of RAR. Propensity score matching (PSM) was performed to adjust for the imbalance of covariates. Logistic regression models and subgroup analyses were carried out to investigate the relationship between RAR and hospital mortality. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of RAR and decision curve analysis (DCA) to assess the clinical utility. Results In total, 1174 patients were finally identified from the MIMIC-IV database. The cutoff value for RAR was 5.315%/g/dL. After PSM at a 1:1 ratio, 638 patients were included in the matched cohort. In the original and matched cohorts, the high RAR group had higher hospital mortality and longer hospital stays. Logistic regression analysis suggested that RAR was an independent risk factor for hospital mortality. The areas under the ROC curve in the original and matched cohorts were 0.706 and 0.611, respectively, which were larger than applying RDW alone (the original cohort: 0.600, the matched cohort: 0.514). The DCA indicated that RAR had a clinical utility. Conclusion A higher RAR (>5.315%/g/dL) was associated with hospital mortality in COPD patients admitted to ICU. As an easily available peripheral blood marker, RAR can predict hospital mortality in critically ill patients with COPD independently.

Predictive role of neutrophil‐percentage‐to‐albumin, neutrophil‐to‐lymphocyte and eosinophil‐to‐lymphocyte ratios for mortality in patients with COPD: Evidence from NHANES 2011–2018

“…High red blood cell distribution width (RDW) and hypoalbuminemia have also been shown to be associated with poor prognosis in COPD patients. 29 Among COPD patients admitted to the intensive care unit, higher RDW-albumin ratios were associated with short-term mortality. 29 In the present study, we confirmed that NPAR and NLR are both predictive of COPD mortality, and the performance of NPAR is slightly better than that of NLR.…”

“…29 Among COPD patients admitted to the intensive care unit, higher RDW-albumin ratios were associated with short-term mortality. 29 In the present study, we confirmed that NPAR and NLR are both predictive of COPD mortality, and the performance of NPAR is slightly better than that of NLR. NPAR is a relatively new inflammatory marker, and few studies have explored its prognostic value.…”

“…We did not assess the prognostic impact of blood cell distribution width (RDW). High red blood cell distribution width (RDW) and hypoalbuminemia have also been shown to be associated with poor prognosis in COPD patients 29 . Among COPD patients admitted to the intensive care unit, higher RDW‐albumin ratios were associated with short‐term mortality 29 …”

Association of red cell distribution width/albumin ratio and in hospital mortality in patients with atrial fibrillation base on medical information mart for intensive care IV database

“…While RDW and albumin have been shown to be associated with an increased risk of atrial fibrillation [ 16 , 35 ], RAR, serving as a composite marker, exhibits a superior predictive effect. In recent years, it has been discovered that RAR is associated with type 2 diabetes and foot ulcers [ 36 ], chronic kidney disease [ 20 ], chronic obstructive pulmonary disease [ 21 ], acute myocardial infarction [ 22 ] and heart failure [ 37 ]. In AF, where inflammatory processes are known contributors, an elevated RDW/ALB ratio may signify a pro-inflammatory state.…”

Red blood cell distribution width/albumin ratio is a novel risk factor of incidence and long-term mortality in chronic heart failure patients: three large cohorts from China and America

“…In mortality, the cut-off value of RAR is different in various research. In ICU, the cut-off RAR value was 5.51[30] for cancer, 5.315 for chronic obstructive pulmonary disease[34], 4.882 for septic patients with atrial fibrillation[35], 5.5 for sepsis[31], and 5.4 for aortic aneurysms[36]. And in non-ICU wards, the cut-off value was 3.809 for patients with diabetic foot ulcers[29].…”