Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 10:17:1797-1809.
doi: 10.2147/COPD.S371765. eCollection 2022.

Association Between Red Blood Cell Distribution Width-Albumin Ratio and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Study

Yuanjie Qiu  1 , Yan Wang  1 , Nirui Shen  1 , Qingting Wang  1 , Limin Chai  1 , Jin Liu  1 , Yuqian Chen  1 , Manxiang Li  1
Affiliations

Association Between Red Blood Cell Distribution Width-Albumin Ratio and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Study

Yuanjie Qiu et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: High levels of red blood cell distribution width (RDW) and hypoalbuminemia are markers of poor prognosis in chronic obstructive pulmonary disease (COPD) patients. However, few studies have shown that the red blood cell distribution width-albumin ratio (RAR) is related to the mortality of COPD. This study aimed to explore the relationship between RAR and hospital mortality in COPD patients admitted to the intensive care unit (ICU).

Patients and methods: Patients were retrospectively incorporated from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and divided into two groups by a cutoff value of RAR. Propensity score matching (PSM) was performed to adjust for the imbalance of covariates. Logistic regression models and subgroup analyses were carried out to investigate the relationship between RAR and hospital mortality. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of RAR and decision curve analysis (DCA) to assess the clinical utility.

Results: In total, 1174 patients were finally identified from the MIMIC-IV database. The cutoff value for RAR was 5.315%/g/dL. After PSM at a 1:1 ratio, 638 patients were included in the matched cohort. In the original and matched cohorts, the high RAR group had higher hospital mortality and longer hospital stays. Logistic regression analysis suggested that RAR was an independent risk factor for hospital mortality. The areas under the ROC curve in the original and matched cohorts were 0.706 and 0.611, respectively, which were larger than applying RDW alone (the original cohort: 0.600, the matched cohort: 0.514). The DCA indicated that RAR had a clinical utility.

Conclusion: A higher RAR (>5.315%/g/dL) was associated with hospital mortality in COPD patients admitted to ICU. As an easily available peripheral blood marker, RAR can predict hospital mortality in critically ill patients with COPD independently.

Keywords: MIMIC-IV; albumin; chronic obstructive pulmonary disease; hospital mortality; red blood cell distribution width.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart for Patient Inclusion. Note: A total of 1174 COPD patients admitted to the ICU were included in this study.
Figure 2
Figure 2
Subgroup analysis of RAR for predicting hospital mortality.
Figure 3
Figure 3
The ROC curves for RAR, RDW, and serum albumin to predict hospital mortality of COPD patients admitted to ICU in the original cohort (A and C) and the matched cohort (B and D).
Figure 4
Figure 4
The DCA for assessing the clinical utility of RAR in COPD patients admitted to ICU in the original cohort (A) and the matched cohort (B).
See this image and copyright information in PMC

References

    1. Rabe KF, Watz H. Chronic obstructive pulmonary disease. Lancet. 2017;389(10082):1931–1940. doi: 10.1016/S0140-6736(17)31222-9 - DOI - PubMed
    1. Wang H, Naghavi M, Allen C, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1459–1544. doi: 10.1016/S0140-6736(16)31012-1 - DOI - PMC - PubMed
    1. Ruvuna L, Sood A. Epidemiology of chronic obstructive pulmonary disease. Clin Chest Med. 2020;41(3):315–327. doi: 10.1016/j.ccm.2020.05.002 - DOI - PubMed
    1. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA. 1995;274(23):1852–1857. doi: 10.1001/jama.1995.03530230038027 - DOI - PubMed
    1. Afessa B, Morales IJ, Scanlon PD, Peters SG. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med. 2002;30(7):1610–1615. doi: 10.1097/00003246-200207000-00035 - DOI - PubMed