Key result
Higher RDW-to-albumin ratio linked to ~173% higher 28-day mortality in AF patients aged ≥80.
Why the study?
There was limited scientific evidence on the association between the red cell distribution width to albumin ratio and mortality in geriatric individuals aged 80 years or older with AF.
Does a higher red cell distribution width to albumin ratio (RAR) predict increased 28-day mortality in Chinese patients aged ≥80 years with atrial fibrillation?
Cohort (n=1,141)
No
Does a higher red cell distribution width to albumin ratio (RAR) predict increased 28-day mortality in Chinese patients aged ≥80 years with atrial fibrillation?
Effect estimate: HR 2.73 (95% CI 1.11-6.74)
Absolute Event Rate: 18.1% vs 1.6%
p-value: p=<0.001
In patients aged ≥80 years with atrial fibrillation, a higher red cell distribution width to albumin ratio is independently associated with increased 28-day all-cause and cardiovascular mortality.
Should not yet change practice in elderly AF; extends RAR-mortality link but remains hypothesis-generating pending validation.
INTRODUCTION: Atrial fibrillation (AF) is a prevalent heart arrhythmia in elderly adults aged 80 years or older. The red cell distribution width (RDW) to albumin ratio has been acknowledged as a reliable prognostic marker for poor outcomes in a variety of disorders. However, there exists limited scientific evidence on the association of RDW to albumin (RAR) with mortality in geriatric individuals with AF. METHODS: From January 2015 to June 2020, a retrospective study was conducted in a tertiary academic institution that diagnosed 1,141 elderly adults with AF. The RAR value was calculated as the ratio of RDW (%) to albumin (g/dL). The potential association between RAR and cardiovascular mortality and the risk of all-cause mortality within 28 days was evaluated by means of multivariable Cox regression analysis. RESULTS: The 28-day all-cause and cardiovascular mortality rates were 8.7% and 3.3%, respectively. Increased RAR tertiles were found to be significantly associated with greater all-cause mortality (T1: 1.6%; T2: 6.2%; T3: 18.1%, p < 0.001) and cardiovascular mortality (T1: 0.8%; T2: 2.9%; T3: 6.3%, p < 0.001) using Kaplan-Meier analysis. Continuous RAR had a positive association with all-cause mortality (hazard ratios [HR] = 1.42, 95% confidence interval [CI] 1.23-1.65) and cardiovascular mortality (HR = 1.31, 95% CI: 1.05-1.64), even after accounting for numerous confounding variables. In comparison to the T1 group, individuals with the highest RAR levels displayed a greater risk of all-cause mortality (HR = 2.73, 95% CI: 1.11-6.74) and cardiovascular mortality (HR = 2.59, 95% CI: 0.69-9.78). Increased RAR levels were related to higher rates of cardiovascular and all-cause mortality across almost all subgroups. CONCLUSION: RAR is independently correlated with 28-day all-cause mortality and cardiovascular mortality in AF-affected individuals aged ≥80.
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Chen et al. (2023) conducted a cohort in Atrial fibrillation (n=1,141). Red cell distribution width to albumin ratio (RAR) vs. Lower RAR tertiles (T1) was evaluated on 28-day all-cause mortality (HR 2.73, 95% CI 1.11-6.74, p=<0.001). Higher red cell distribution width to albumin ratio (T3 vs T1) was significantly associated with increased 28-day all-cause mortality (HR 2.73; 95% CI 1.11-6.74) in AF patients aged ≥80 years.
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