Sepsis-associated delirium (SAD) is a common and severe acute neuropsychiatric manifestation in patients with sepsis, which is associated with increased mortality and lasting cognitive deficits. The red cell distribution width to albumin ratio (RAR) has been recognized as a robust prognostic indicator for adverse outcomes across various diseases. This study aims to investigate the relationship between RAR and short-term mortality in patients with SAD after admission to the intensive care unit (ICU).

This retrospective cohort study leveraged the MIMIC-IV 3.1 database to analyze the primary outcome of all-cause mortality within 30 days of ICU admission for patients with SAD. According to the receiver operating characteristic(ROC) curve to determine the optimal cut-off point of RAR, SAD patients were divided into low RAR group (RAR < 5.85) and high RAR group (RAR ≧ 5.85). To mitigate potential confounding factors, a 1:1 propensity score matching (PSM) method was implemented. The relationship between RAR and short-term mortality was further assessed using multivariate Cox proportional hazards regression models and Kaplan-Meier (KM) survival curve analyses.

The study included 4021 patients with SAD. After PSM, 1063 score-matched pairs of patients were generated. Cox proportional hazards models were adjusted for potential confounders, Patients with elevated RAR (≥ 5.85) exhibited a significantly higher 30-day mortality rate compared to those with a lower RAR (< 5.85), with a hazard ratio (HR) of 1.53 (95% CI: 1.35-1.75, P < 0.001). Propensity scores matching analysis corroborated these results, consistently indicating a higher mortality rate in the high RAR group, with an HR of 1.39 (95% CI: 1.19-1.61, P < 0.001).

An Elevated RAR upon ICU admission was independently associated with an increased risk of short-term mortality in patients with SAD.

Acute pancreatitis (AP) is an inflammatory disease that causes significant morbidity and mortality. Red blood cell distribution width (RDW) and platelet distribution width (PDW) are commonly used and easily measurable indicators that provide valuable information about an individual's inflammatory condition. This study aimed to evaluate the diagnostic value of RDW and PDW in comparison with other scoring systems for predicting the severity of AP.

The present study with a retrospective cross-sectional design was conducted on 115 patients admitted to Imam Khomeini Hospital in Ahvaz from 2018 to 2021. The variables that were measured included demographic characteristics, comorbidities, hospitalization, laboratory parameters, prognostic scoring systems (Ranson and bedside index for severity in acute pancreatitis (BISAP)), and mortality rates. A comparison was made between various parameters in patients diagnosed with mild and severe AP. The prognostic value of RDW and PDW in determining the severity of AP was determined using the receiver operating characteristic (ROC) curve.

Severe AP patients exhibited higher Ranson and BISAP scores (P < 0.01) and experienced a longer duration of hospital stay (P < 0.01) compared with AP patients. PDW was found to be significantly elevated in AP patients compared to those with mild AP (17.77 ± 25.11 vs. 14.8 ± 1.67; P = 0.02). There were no statistically significant differences in the RDW in mild and severe AP patients (14.0 ± 3.59 versus 14.19 ± 5.9; P = 0.90).

The findings of the study suggest that utilizing PDW as an indicator of inflammation can serve as a valuable approach to evaluating the progression of AP. However, RDW does not offer significant assistance in the early prediction of AP severity. Nonetheless, it is crucial to conduct future prospective studies with larger sample sizes, including all pancreatitis cases.

Acute pancreatitis is a potentially life-threatening inflammatory condition with variable clinical presentations. Early risk stratification remains challenging despite existing scoring systems. The red blood cell distribution width-to-albumin ratio (RAR) has emerged as a potential prognostic biomarker in inflammatory conditions. This systematic review and meta-analysis aimed to evaluate the association between admission RAR and outcomes in acute pancreatitis. We conducted a comprehensive literature search and identified five retrospective studies meeting the inclusion criteria. Meta-analysis was performed to assess the relationship between RAR and mortality as well as disease severity in acute pancreatitis patients. Pooled analysis demonstrated that elevated RAR was significantly associated with increased mortality risk (risk ratio (RR): 2.11, 95% confidence interval (95% CI): 1.35-3.30) with moderate heterogeneity (I²: 46%). When comparing disease severity, mean RAR values were significantly lower in mild acute pancreatitis compared to severe cases (mean difference (MD): -1.78, 95% CI: -2.09 to -1.46), also with moderate heterogeneity (I²: 44%). This meta-analysis suggests that RAR, a simple and cost-effective biomarker available from routine blood tests, may serve as a valuable prognostic indicator for mortality and severity in acute pancreatitis. Despite having comparatively lower discriminative ability than conventional scoring systems, RAR offers advantages in terms of rapid assessment and cost efficiency. However, limitations include the small number of included studies, their retrospective nature, and heterogeneity in study settings. Further prospective studies are warranted to validate these findings.

Red blood cell volume distribution width (RDW) and albumin (Alb) have been proved to be predictors of mortality in various diseases, such as acute pancreatitis (AP). However, until now the relationship between RDW to Alb ratio (RAR) and mortality in AP has not been fully elucidated. Therefore, this study aims to evaluate the relationship between RAR and all-cause mortality in AP.

Patients with AP in the Critical Care Medical Information Market (MIMIC-IV) database who met criteria were included in this retrospective study. Associated baseline data was obtained, cleaned and analyzed. Kaplan Meier (K-M) survival curve and Cox proportional hazards regression model were utilized to evaluate the relationship between RAR and all-cause mortality. Restricted Cubic Spline (RCS) was used for exploring how hazard ratio (HR) changes as RAR varied. Additionally, Receiver Operating Characteristic (ROC) analysis and subgroup analysis were conducted to assess the predictive value and to explore the significance of RAR in different populations.

499 patients were included in this study. Survival curve showed that patients with RAR > 5.14 had higher mortality rate at 7-day (d), 14-d, 21-d, 28-d, 90-d, 180-d and 1-year (y). The univariate and multivariate Cox models revealed an independent association between high-level RAR and all-cause mortality at 28-d, 90-d and 1-y. RCS showed that RAR became a risk factor when exceeding 5.14. RAR only had linear relationship with mortality at 1-y after adjusting for the potential confounders. Subgroup analysis suggested that increased RAR caused higher risk of death in male, non-white people or those patients without respiratory failure (RF). ROC analysis indicated that compared with other parameters such as SOFA score, RAR exhibited higher efficiency in predicting in-hospital and all-cause mortality at 14-d, 21-d, 28-d, 90-d. Combined RAR with BISAP, RAR-modified BISAP showed superiority in predicting short-term mortality (28-d).

For patients with AP in ICU, RAR has a strong association with short- and long-term prognosis. Especially, RAR is a promising indicator for short-term all-cause mortality in patients with AP. For males, non-white patients and those without RF, elevated RAR may be a more dangerous signal of mortality.

The association between red blood cell distribution width-to-albumin (RDW/ALB) ratio (RAR) and all-cause mortality in patients with acute pancreatitis has not been fully delineated. The purpose of this study was to investigate the impact of RAR at admission on 28-day all-cause mortality in patients with acute pancreatitis.

This investigation was conducted as a retrospective analysis utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-III database.

Patients with acute pancreatitis were selected from the MIMIC-III database according to predefined eligibility criteria.

The outcome was the all-cause mortality rates within 28 days.

Upon screening and excluding ineligible participants, a total of 931 patients with acute pancreatitis who met the inclusion criteria were analyzed. The overall mortality at 28 days was 11.71%. The receiver operating characteristic (ROC) analysis indicated that RAR had a moderate predictive value for all-cause mortality at 28 days, with an area under the curve (AUC) of 0.669 (95%CI, 0.617-0.720; p<0.05), and the cutoff value was 4.39. Divide the patients into a high RAR group and a low RAR group based on the cutoff value. Kaplan-Meier survival analysis demonstrated a statistically significant increase in 28-day mortality among patients in the high RAR group compared to those in the low RAR group. Multivariate analysis indicated that potassium levels, total bilirubin, blood urea nitrogen, lactate, partial thromboplastin time, neutrophil and RAR were independently associated with the 28-day mortality. Multivariate Cox regression analysis confirmed that an elevated RAR was independently associated with increased mortality at 28 day (HR, 2.72; 95% CI, 1.64-4.52; p < 0.001).

This study demonstrated that RAR at admission functioned as a significant prognostic indicator for mortality in patients with acute pancreatitis.

The red blood cell distribution width (RDW) and serum albumin levels are potential indicators of inflammatory conditions. However, the relationship between the RDW to albumin ratio (RAR) and the prevalence of kidney stones in the general adult population is not yet established.

This study utilized data from the 2007 to 2018 National Health and Nutrition Examination Survey (NHANES) project. RAR levels were calculated by dividing RDW by albumin. Multiple logistic regressions and restricted cubic spline (RCS) regression were applied to examine the associations between RDW, albumin, RAR, and the prevalence of kidney stones.

A total of 31,417 adults (2987 participants with kidney stones) were included for analysis. The mean age of the participants was 47.84 ± 0.23 years, and 48.86% were male. The mean of RDW, albumin, and RAR was 13.25 ± 0.02%, 4.26 ± 0.01 g/dL, and 3.14 ± 0.01, respectively. Compared to the first quartile, the fourth quartile of RDW (OR = 1.44 [1.21-1.72], Ptrend < 0.001) and RAR (OR = 1.62 [1.35-1.95], Ptrend < 0.001) were positively associated with the prevalence of kidney stones, whereas albumin (OR = 0.75 [0.63-0.89], Ptrend < 0.001) was negatively associated with the prevalence of kidney stones after multivariable adjustment. Furthermore, we found that both RDW and RAR levels were positively and non-linearly related to the prevalence of kidney stones, with inflection points of 13.50% and 3.23, respectively. On the other hand, serum albumin concentrations exhibited a linear association with the prevalence of kidney stones.

Our findings suggest that higher RAR levels are associated with an increased prevalence of kidney stones in the general adult population.

The red blood cell distribution width (RDW) to albumin (ALB) ratio (RAR) has been identified as a prognostic indicator for mortality in critically ill patients across various diseases. Nevertheless, the impact of RAR on clinical functional prognosis in Acute ischemic stroke (AIS) remains uncertain. This study aimed to evaluate the prognostic significance of RAR in AIS patients.

A secondary analysis was performed on a cohort study, involving 1906 AIS patients recruited from a South Korean academic hospital. Both univariate and multivariate logistic regression was employed to assess the connections between RAR and negative functional results in AIS. To explore potential non-linear relationships in this association, a generalized additive model (GAM) and smooth curve fitting were utilized. Further, a mediation analysis was performed to identify possible mediators.

Out of the 1906 eligible patients, 546 (28.65%) were found to have an unfavorable prognosis. Patients with elevated RAR had a higher likelihood of facing a negative prognosis in AIS (all P<0.001). RAR demonstrated a dose-response relationship with the probability of poor functional prognosis. When analysis of RAR as a continuous variable, an increase in RAR was correlated with a higher risk of adverse prognosis.When RAR was analyzed as quartile variables, the highest RAR remained an independent contributing factor for both 3-month unfavorable outcomes (adjusted OR, 1.4; 95% CI: 1.0-2.1, P=0.046) and 3-month mortality (adjusted OR, 5.2; 95% CI, 2.0-13.9; p<0.001). More interestingly, the presence of a pro-inflammatory state may serve as a mediator in the connections between RAR and adverse functional outcomes.

Given its cost-effectiveness and ease of measurement, baseline RAR holds promise as a valuable biomarker for early risk assessment in AIS patients.

This letter addresses the study titled "Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis" by Lv et al published in the World Journal of Experimental Medicine. The study offers a valuable analysis of red cell distribution width (RDW) as a predictive marker for persistent organ failure in patients with hypertriglyceridemia-induced acute pancreatitis. The study results suggest that RDW, combined with the Bedside Index for Severity in Acute Pancreatitis score, could enhance the predictive accuracy for severe outcomes. Further investigation into the role of RDW in different severities of acute pancreatitis is recommended. Additionally, the need for large-scale and multicenter prospective studies to validate these findings is emphasized.

Ongoing research is seeking to identify the best prognostic marker for acute pancreatitis (AP). The purpose of this study was to investigate the role of the red blood cell distribution width-to-albumin ratio (RAR) in the prognosis of AP.

This 18-month prospective cohort study was conducted between June 2021 and December 2022 with patients diagnosed with AP. The patients were divided into two groups: severe AP (SAP) and non-severe AP. Factors associated with SAP within the first 48 h of admission were determined. In addition, RAR values at admission and at 48 h (RAR-48th) were calculated, and their ability to predict clinical outcomes was assessed. The primary outcomes were severe disease and in-hospital mortality.

Fifty (13.7 %) of 365 patients had SAP. Systemic inflammatory response syndrome, blood urea nitrogen, calcium, and RAR at 48 h after admission were independent predictors of SAP. When RAR-48th was >4.35, the risk of SAP increased approximately 18-fold (OR: 18.59; 95 % CI: 8.58-40.27), whereas no patients with a RAR-48th value of <4.6 died. For in-hospital mortality, the area under the curve (AUC) value of RAR-48th was 0.960 (95 % CI: 0.931-0.989), significantly higher than the AUC values of existing scoring systems. The results of RAR-48th were comparable to those of the other scoring systems with regard to the remaining clinical outcomes.

RAR-48th successfully predicted clinical outcomes, particularly in-hospital mortality. Being simple and readily calculable, RAR-48th is a promising alternative to burdensome and complex scoring systems for the prediction of clinical outcomes in AP.

Red blood cell distribution width/albumin ratio (RAR) has been reported as an independent risk factor for diabetic retinopathy (DR), while its association and predictive value in the prognosis of DR patients has not been reported. This study aims to explore the association and predictive value of RAR in the prognosis of DR patients.

This was a retrospective cohort study based on the National Health and Nutrition Examination Survey (NHANES). The independent variable was RAR, and dependent variables were all-cause mortality and cardiovascular diseases (CVD) mortality. The association between RAR and the risk of all-cause mortality and CVD mortality was assessed using univariate and multivariate cox regression models. The results were shown as HR (hazard ratio) with 95% confidence intervals (CIs). Subgroup analysis based on age or hyperlipidemia was performed. The discrimination of the prediction model was assessed using concordance index (C-index).

A total of 725 eligible patients were finally included in this study. The increase of RAR was associated with increased risk of all-cause mortality (HR: 1.15, 95%CI: 1.01-1.31) and CVD mortality (HR: 1.35, 95%CI: 1.12-1.63) after adjusting the covariates. We also found the significant association between higher RAR and higher risk of CVD mortality in DR patients with age < 65 years (HR: 1.35, 95%CI: 1.09-1.67) and with hyperlipidemia (HR: 1.34, 95%CI: 1.10-1.64). C-index of RAR for all-cause mortality and CVD mortality was 0.63 (95%CI: 0.59-0.67) and 0.65 (95%CI: 0.59-0.71), respectively.

Higher RAR was associated with the higher risk of all-cause mortality and CVD mortality in DR patients, and RAR may be a useful predictor for the prognosis of DR patients.