Acute heart failure patients with a high red blood cell distribution width-to-albumin ratio have an increased risk of all-cause mortality

Background: Many studies have shown that specific blood markers, such as red cell distribution width (RDW) and albumin levels, can provide valuable information about the prognosis of patients with acute heart failure (AHF). In light of these findings, the current study aims to investigate the relationship between another blood marker, RDW to albumin ratio (RAR), and the prognosis of AHF patients. Methods: Data on patients diagnosed with AHF were extracted from the MIMIC-IV database version 2.1. Patients were divided into three groups based on RAR tertiles. Multiple imputation was used for missing data, and pooled analysis was performed for imputed data sets. This study used Cox regression analysis to evaluate the impact of RAR on Clinical Outcomes in AHF patients. To further assess the prognostic ability of RDW, RAR, and albumin, the study also used time-dependent receiver operating characteristic (time-ROC) analysis. Results: This study enrolled 1432 patients with AHF, with a mean age of 72.4 years and a mean RAR of 5.07 {plus minus} 1.51% /g/dl. Patients with AHF had increased all-cause mortality when their RAR was higher (HR = 1.16, 95% CI: 1.10 ~ 1.23, P < 0.001), and RAR and mortality from all causes were linearly related in patients with AHF (P non-linearity = 0.643). Based on time-ROC curves, it was discovered that RAR had a higher prognostic accuracy compared to RDW and albumin. Conclusions: An increased level of RAR was associated with a poor all-cause mortality prognosis for patients with AHF, and there is a significant linear relationship. RAR was a better predictor of all-cause mortality in AHF patients than RDW and albumin. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No external funding was received. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Name of the ethics committee: the Ethics Committee of the Second Affiliated Hospital of Shandong First Medical University I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The MIMIC-IV V2.1 was used in this study. The database can be downloaded here: https://physionet.org/content/mimiciv/2.1/.