What question did this study set out to answer?

This research aims to evaluate the predictive value of the red blood cell distribution width-to-albumin ratio (RAR) on mortality outcomes in non-anemic elderly patients with hip fractures.

March 25, 2026Open Access

Red Blood Cell Distribution Width-to-Albumin Ratio (RAR) Is an Independent Predictor of Mortality in Non-Anemic Elderly with Hip Fractures

Puntos clave

This research aims to evaluate the predictive value of the red blood cell distribution width-to-albumin ratio (RAR) on mortality outcomes in non-anemic elderly patients with hip fractures.
Retrospective analysis of 622 elderly patients (≥ 70 years) treated for hip fractures
Mortality outcomes assessed at multiple time points post-surgery: 30 days, 3 months, 6 months, and 1 year
Patients stratified into quartiles based on RAR
Kaplan–Meier survival analysis and Cox regression used to analyze predictive value
ROC curves employed to compare RAR with RDW alone.
Mortality rates increased across RAR quartiles, with Q4 showing 21.13% and Q1 showing 4.08% at 1 year (P<0.001)
RAR identified as an independent mortality predictor in non-anemic patients (HR=12.52, P<0.001)
No significant mortality prediction found for anemic patients (HR=1.89, P=0.129)
RAR outperformed RDW alone in mortality prediction accuracy.

Resumen

Background: Hip fractures in elderly patients are associated with high morbidity and mortality, and effective prognostic biomarkers to guide risk stratification remain scarce. The red blood cell distribution width-to-albumin ratio (RAR), reflecting both inflammatory and nutritional status, has shown predictive value in other diseases but has not been evaluated in hip fractures. Methods: This retrospective single-center study analyzed 622 elderly patients with hip fractures (aged ≥ 70 years) treated at Peking University First Hospital between 2015 and 2021. Patients were stratified into quartiles according to RAR (Q1–Q4), and mortality outcomes were assessed at 30 days, 3 months, 6 months, and 1 year after surgery. The prognostic significance of RAR was examined using Kaplan–Meier survival analysis, Cox proportional hazards models, and receiver operating characteristic (ROC) curves. Results: Mortality increased progressively across RAR quartiles, with patients in the highest quartile (Q4) showing a 1-year mortality rate of 21.13%, compared with 4.08% in the lowest quartile (Q1) (P< 0.001). Multivariable Cox regression analysis demonstrated that RAR was an independent predictor of mortality in non-anemic patients (Q4 vs. Q1: HR=12.52, 95% CI 3.18– 49.24, P< 0.001), whereas no significant association was observed in anemic patients (Q4 vs. Q1: HR=1.89, 95% CI 0.83– 4.30, P=0.129). ROC analysis further indicated that RAR provided superior discriminatory performance compared with red blood cell distribution width (RDW) alone. Conclusion: RAR represents a novel and independent predictor of postoperative mortality in elderly non-anemic patients with hip fractures, offering greater predictive accuracy than RDW alone. Incorporating RAR into clinical risk stratification models may improve prognostic assessment and support individualized treatment planning. Validation through multicenter prospective studies and further investigation of underlying mechanisms are warranted. Keywords: RDW/ALB, Hip fracture, mortality, older people

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