Key result
Higher red cell distribution width-to-albumin ratio linked to ~32% higher ICU mortality in aortic dissection.
Why the study?
Critically ill patients with aortic dissection remain at high risk of adverse ICU outcomes, and although the red cell distribution width-to-albumin ratio (RAR) has been investigated as a prognostic marker in various settings, its association with ICU outcomes in aortic dissection required evaluation.
Is a higher early-ICU red cell distribution width-to-albumin ratio (RAR) associated with increased ICU mortality and adverse ICU outcomes in critically ill patients with aortic dissection?
Cohort (n=267)
No
Is a higher early-ICU red cell distribution width-to-albumin ratio (RAR) associated with increased ICU mortality and adverse ICU outcomes in critically ill patients with aortic dissection?
Although higher early-ICU red cell distribution width-to-albumin ratio (RAR) is associated with ICU mortality, sepsis, and RRT use in patients with aortic dissection, its standalone discriminative ability is modest (AUC 0.66) and it does not significantly improve prognostication over the SOFA score alone.
Answers are grounded in this paper and cite their sources.
Higher RAR was associated with ICU mortality in aortic dissection; leaves open incremental value beyond SOFA for prognostication.
Objective Critically ill patients with aortic dissection remain at high risk of adverse ICU outcomes, including ICU mortality. The red cell distribution width-to-albumin ratio (RAR) has been investigated as a prognostic marker in various clinical settings. This study aimed to evaluate the association of RAR with ICU outcomes in patients with aortic dissection. Methods Data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. ICU mortality was defined as the primary outcome. Secondary outcomes included sepsis during hospitalization/ICU stay, acute kidney injury (AKI), and renal replacement therapy (RRT) use. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative performance of RAR for ICU mortality. The optimal RAR cutoff was determined using Youden's index and was considered exploratory. Calibration plots and decision curve analysis were used to evaluate model performance. Results RAR showed modest discrimination for ICU mortality (AUC: 0.66; 95% CI: 0.552–0.765). The exploratory cutoff value of RAR was 5.182. Compared with the low-RAR group, the high-RAR group had higher ICU mortality (21.8% vs. 6.7%; P < 0.001), a higher prevalence of sepsis during hospitalization/ICU stay (82.8% vs. 61.1%; P < 0.001), and more frequent RRT use (33.3% vs. 9.4%; P < 0.001). The AUC increased from 0.706 for SOFA alone to 0.731 for SOFA plus RAR, indicating only limited incremental discrimination. Conclusion Higher early-ICU RAR was associated with ICU mortality and other adverse ICU outcomes in patients with aortic dissection, but its discrimination was modest, its incremental value beyond SOFA was limited, and external validation is required.
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Li et al. (2026) conducted a cohort in Aortic dissection (n=267). High red cell distribution width-to-albumin ratio (RAR > 5.182) vs. Low red cell distribution width-to-albumin ratio (RAR ≤ 5.182) was evaluated on ICU mortality (OR 1.32, 95% CI 1.01–1.72, p=0.043). Higher early-ICU red cell distribution width-to-albumin ratio was associated with increased ICU mortality in aortic dissection patients (21.8% vs 6.7%, P<0.001; adjusted OR 1.32, 95% CI 1.01–1.72).
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