Long-term Prognostic Value of the Ratio of Red Blood Cell Distribution Width to Albumin in Patients With Acute Decompensated Heart Failure Patients

Backgrounds: Previous studies have shown that the ratio of red cell distribution width to serum albumin level (RAR) is an integrative and new inflammatory marker. RAR is associated with clinical outcomes in a variety of diseases, but there is no information available on the long-term prognostic value of RAR in patients admitted for acute decompensated heart failure (ADHF) after the discharge. Methods and Results: We studied 302 patients admitted for ADHF and discharged with survival. The RAR was calculated as RDW (in %) / albumin (in g/dL) on admission or at discharge. The primary and secondary endpoints of this study were cardiovascular death (CVD) and all-cause death (ACD), respectively. During a follow-up period of 4.2±3.3 yrs, 69 patients had CVD and 96 patients had ACD. ROC curve analysis revealed that AUC of RAR at the discharge (0.677[0.605-0.749]) was significantly (p=0.001) greater than that on admission (0.583[0.511-0.656]). At multivariate Cox analysis, RAR at the discharge, but not on admission, was significantly associated with CVD and ACD, independently of the prior history of heart failure hospitalization, BMI, systolic blood pressure, estimated glomerular filtration rate and serum sodium level after the adjustment with hemoglobin level and left ventricular dimension index. Patients with higher RAR ≥4.23 (by ROC analysis) had a significantly higher risk of CVD and ACD than those with lower RAR<4.23 (CVD: 38% vs 15%, p<0.0001, ACD: 47% vs 25%, p<0.0001, respectively). Conclusion: In the present study, a higher RAR at the discharge but not on admission was associated with an increased risk of cardiovascular death and all-cause death in ADHF patients after the discharge. These findings suggest that RAR may be a simple and inexpensive indicator for identifying ADHF patients at high risk of mortality.