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. 2025 Apr 29:18:5811-5819.
doi: 10.2147/JIR.S513844. eCollection 2025.

The Red Blood Cell Distribution Width to Albumin Ratio Is Associated with in Hospital Mortality and Adverse Outcome in Elderly Chinese Patients with Gastrointestinal Bleeding

Fan Zhang  1 , Jie Chen  2 , Yu-Jun Xiong  1 , Hua Wang  3 , Qing-Feng Luo  1
Affiliations

The Red Blood Cell Distribution Width to Albumin Ratio Is Associated with in Hospital Mortality and Adverse Outcome in Elderly Chinese Patients with Gastrointestinal Bleeding

Fan Zhang et al. J Inflamm Res. .

Abstract

Background: Gastrointestinal bleeding (GIB) in elderly patients is a common and life-threatening condition, often complicated by comorbidities. The ratio of red blood cell distribution width to albumin (RAR) has recently been proposed as a prognostic marker in various diseases, but its role in predicting adverse outcomes in GIB patients remains unclear.

Methods: A total of 51,824 aged 65 years or older patients were initially screened for inclusion in the study. After excluding those lost to follow-up, with missing vital information during the screening period (n = 50,423), 1401 hospitalized patients with GIB in Beijing Hospital (2013-2019) were included. Restricted cubic spline modeling and logistic regression analyses assessed the relationships between RAR, adverse outcomes, and in hospital mortality.

Results: Among the 1, 401 patients, 648 experienced adverse outcomes, and 427 patients died during hospitalization. Higher RAR was significantly associated with an increased risk of both in-hospital mortality and adverse outcomes, even after adjusting for age, sex, education level, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), cancer, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), white blood cell count (WBC), estimated glomerular filtration rate (eGFR), hemoglobin, heart failure, blood urea nitrogen (BUN), and heart rate.

Conclusion: RAR is a novel and independent predictor of mortality and adverse outcomes in elderly patients with GIB. Its simplicity and cost-effectiveness make it a valuable tool for identifying high-risk patients. Further studies in larger, multicenter cohorts are needed to confirm these findings and evaluate the clinical benefits of RAR-based interventions.

Keywords: RAR; adverse outcomes; elderly; gastrointestinal bleeding; mortality.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart for inclusion and exclusion of the study population.
Figure 2
Figure 2
(A) Restricted cubic spline (RCS) for the association between RAR and the risks of adverse outcome in patients with gastrointestinal bleeding; (B) RCS for the association between RAR and the risks of in hospital death in patients with gastrointestinal bleeding.
See this image and copyright information in PMC

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