Association of Red Blood Cell Distribution Width-Albumin Ratio for Acute Myocardial Infarction Patients with Mortality: A Retrospective Cohort Study

Abstract

Background Red blood cell distribution width (RDW) was a risk factor for poor prognosis in acute myocardial infarction (AMI). Recent reports suggested that combining RDW with other laboratory metrics could provide a better prediction. This retrospective study aimed to investigate whether the RDW-albumin ratio (RAR) may be associated with mortality after an AMI. Methods This cohort study was conducted among adults (over 16 years old) with AMI in the Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III). The primary outcome was 30-day mortality, and the secondary outcome was 1-year and 3-year mortality. Cox hazard regression model and Kaplan–Meier survival curves were constructed to estimate the effect of biomarkers on mortality. We used three models to adjust for potential bias. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for the excellent performance of RAR on prognosis. Results A total of 826 patients were eventually enrolled in our study. In multivariate analysis, RAR was found to be associated with 30-day mortality (Model 3: HR = 1.23, 95% CI = 1.09-1.39, P < .001). In addition, Subgroup analysis showed that the effect of RAR was higher in female patients than in male patients ( P for interaction = .026). Kaplan-Meier survival curves showed that patients in the lower RAR quartile tended to have higher survival rates in the short and long term. AMI patients with RAR ≥ 4 had a 122% increase in 3-year mortality. Results of ROC and AUC showed that the prognostic performance of RAR for mortality was the best (30-day mortality: 0.703; 1-year mortality: 0.729; 3-year mortality: 0.737). Conclusions RAR is a simple and stable predictor of prognosis in AMI patients. Our results support RAR = 4.0 as a criterion for prognostic risk stratification of AMI patients.

Relationship between red cell distribution width/albumin ratio and carotid plaque in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

“…And the relationship between RAR and carotid plaque was stronger in patients under 60 years of age than in those over 60 years of age. Similar results were found in a previous retrospective cohort study of the association of RAR in patients with AMI, the subgroup analysis showed that the effect of RAR was higher in female patients than in male patients [ 43 ]. We thought it might have something to do with women’s hormone levels.…”

“…In recent years, studies have shown that RAR is closely related to CHD, and it may be a key indicator for evaluating the severity of CVD. Li et al found that RAR is a simple and a risk factor for poor prognosis in acute myocardial infarction (AMI) patients, the lower RAR level, the higher the short-term and long-term survival rate of patients [ 43 ]. Weng et al believed that RAR had a better predictive ability for all-cause mortality of patients after PCI, and was superior to RDW or ALB alone.…”

Relationship between the Ratio of Red Cell Distribution Width to Albumin and 28-Day Mortality among Chinese Patients over 80 Years with Atrial Fibrillation

“…The prognosis of some conditions, such as ischemic stroke, heart failure, and other cardiovascular disorders, was in fact correlated with RAR [16, 17, 40, 41]. Previous reports revealed that RAR was positively related to long- and short-term mortality among myocardial infarction or acute heart failure patients [16, 17]. According to one of the reported studies, RAR is a simple-to-use biomarker for predicting stroke-associated infections and death in stroke patients [40].…”

“…Serum albumin is an essential protein that serves as a marker of nutritional status and facilitates the transportation of various drugs and molecules [15]. Recent studies have suggested that the ratio of RDW to albumin (RAR) is closely linked to adverse outcomes in patients with acute myocardial infarction, heart failure, diabetes, respiratory disorders, and other diseases [16][17][18][19]. Despite the insufficient information on the association of RAR with mortality in older individuals suffering from AF, this research aimed to examine the association of RAR with the risk of 28-day all-cause and cardiovascular mortality in hospitalized elderly AF patients (≥80 years) in China.…”

Association between red blood cell distribution width-to-albumin ratio and prognosis of patients with acute myocardial infarction

“…Similar to these results, our study showed that high RDW level was interconnected with an increased risk of death for AMI patients, and high albumin level might be a protective factor of death risk in patients with AMI. In the study of Li et al, they reported that RAR (RDW-to-albumin Ratio) was an independent predictor for 30-day mortality of patients with first-onset AMI [ 28 ]; however, they did not consider the effect of severity score as well as treatment modality. Remarkably, this study indicated that after adjusted for age, marital status, respiratory rate, heart rate, DBP, WBC, potassium, calcium, pH, creatinine, bicarbonate, hemoglobin, SpO2, vasopressor use, SOFA score, SAPS II score, GCS score ECI score, PCI, CABG and ICU length, high RAR level was a risk factor of the 90-day mortality for AMI patients, which may be related to the fact that both RDW and albumin were independent predictors of AMI.…”