Red blood cell distribution width–albumin ratio: a promising predictor of outcome in heart failure patients—a 6-year cohort study

BACKGROUND: Heart failure (HF) is a global health burden, affecting millions of people worldwide. This prospective study aimed to investigate the prognostic value of the red blood cell distribution width-albumin ratio (RAR) in HF patients. METHODS: This two-center cohort study included patients with symptomatic HF (NYHA functional class III-IV) from 2014 to 2016. Survival analysis, logistic regression, and Kaplan-Meier curves were employed to assess the association between RAR and prognosis. RESULTS: The study included 2151 HF patients. Significant differences in clinical profiles were observed across RAR groups. Patients with higher RAR were more likely to be female and had a greater prevalence of comorbidities such as atrial fibrillation, renal insufficiency, and hypoproteinemia. During the 6-year follow-up period, higher RAR was significantly associated with reduced survival probability (P < 0.001). Elevated RAR was independently associated with a higher risk of HF re-hospitalization [HR(95% confidence interval; CI): 1.848 (1.502-2.275), P < 0.001], cardiac death [HR (95% CI): 1.334 (1.074-1.657), P = 0.009], and all-cause death [HR(95%CI): 1.575 (1.283-1.933), P < 0.001] at 3 months. Furthermore, elevated RAR independently predicted a higher risk of HF re-hospitalization at 6 years [HR(95%CI): 1.457(1.271-1.671), P < 0.001] and all-cause mortality [HR(95%CI): 1.507 (1.318-1.723), P < 0.001]. CONCLUSIONS: Elevated RAR levels are independently associated with a worse prognosis in HF patients, including higher risks of HF re-hospitalization and all-cause mortality. The RAR holds promise as a valuable tool for risk stratification and prognosis assessment in HF management.