Red cell distribution width–to–serum albumin ratio (RAR) in chronic heart failure
Ana Toste, Mariana Matos, Ana Neves, Catarina Elias, Francisca Correia, Helena Reis, Carolina Guimarães, Adriana Costa, Carlos Grijó, Catarina Reis, Ana Fonseca, Marta Carreira, Joana Pereira, Jorge Almeida, Patrícia LourençoAbstract
Background:
Red blood cell distribution width (RDW)–to-albumin ratio (RAR) is a novel biomarker of inflammation. RAR has prognostic value in acute heart failure (HF).
Aim:
We studied the association of RAR with all-cause mortality in chronic HF.
Methods:
A retrospective cohort study was conducted on ambulatory HF patients with left ventricular systolic dysfunction (LVSD) between January 2012 and December 2020. RAR is calculated as RDW (%)/albumin (g/dL). Follow-up was conducted from the first medical appointment until December 2022, and the end point was all-cause mortality. Receiver operating characteristic curve was used to assess the association of RAR with all-cause mortality and to choose the best cutoff. A multivariate Cox regression analysis was used to assess the independent association between RAR and mortality.
Results:
We studied 754 patients (63.3% male, mean age 71 years); 49.3% had severe LVSD, and 44.4% had ischemic HF. RAR exhibited a skewed right-tailed distribution. The area under the curve was 0.64 (0.61–0.68), and the best cutoff was 3.43. During a median follow-up of 43 months, 370 patients (49.1%) died. Mortality increased with increasing RAR: 33.2% vs 63.1% in patients in the first RAR tertile vs others (
Conclusions:
RAR is a strong and independent mortality predictor in chronic HF. Patients with a RAR ≥3.43 have a 50% higher risk of all-cause mortality in the long term, with a 29% increase in risk per unit increase in ratio.