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. 2025 Dec 23;17(12):e99928.
doi: 10.7759/cureus.99928. eCollection 2025 Dec.

Utility of the Red Cell Distribution Width-to-Albumin Ratio in Predicting Short-Term Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Sai Jeevan P  1 , Gaurav Jain  1 , Ankit Agarwal  1 , Nilotpal Chowdhury  2 , Prakhar Sharma  3 , Vaishnavi Pandith  1 , Mayuri Gupta  1
Affiliations

Utility of the Red Cell Distribution Width-to-Albumin Ratio in Predicting Short-Term Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Sai Jeevan P et al. Cureus. .

Abstract

Background Acute exacerbation of chronic obstructive pulmonary disease (ECOPD) significantly contributes to intensive care unit (ICU) admissions and short-term mortality. The red cell distribution width-to-albumin ratio (RAR) has emerged as a potential biomarker for systemic inflammation and adverse outcomes. This study aimed to assess the diagnostic value of baseline RAR in predicting 28-day all-cause mortality in ICU-admitted patients with acute ECOPD. Methodology In a prospective, observational design, 83 consecutive patients admitted with moderate to severe ECOPD were enrolled. Baseline clinical data, laboratory parameters, and clinical severity scores were collected. Patients were followed up for 28 days. The primary outcome was 28-day all-cause mortality. Receiver operating characteristic (ROC) analysis was used to determine the baseline optimal RAR cut-off. Results A baseline RAR threshold of >5.43%dL/g showed excellent predictive performance for 28-day mortality (area under the receiver operating characteristic (AUROC): 0.979; sensitivity: 95.45%; specificity: 95.08%). Mortality was significantly higher in the high RAR group (87.5%) when compared to the low RAR group (1.69%) (P < 0.001). Kaplan-Meier survival analysis confirmed significantly improved survival in patients with lower RAR. On multivariate analysis, only baseline lactate (P = 0.011) and RAR (P = 0.008) independently predicted mortality. RAR had a poor predictive value for the failure of non-invasive ventilation. Conclusions Baseline RAR is a simple, accessible, and effective biomarker for predicting short-term mortality in ECOPD. Its integration into early ICU risk stratification protocols warrants further validation in larger, multi-center cohorts.

Keywords: albumin; chronic obstructive pulmonary disease; intensive care unit; mortality; red blood cell distribution width.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Ethics Committee, All India Institute of Medical Sciences, Rishikesh issued approval AIIMS/IEC/24/206. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This research was supported by a grant from the Indian Council of Medical Research (ICMR), Department of Health Research, Ministry of Health and Family Welfare, Government of India (Grant letter: No-HRD-Head/PGthesis-program/2023-24(27)). Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flow diagram of the patients studied.
RDW, red cell distribution width
Figure 2
Figure 2. (A) ROC curves of baseline RAR, RDW, and albumin predicting 28-day mortality; (B) ROC curve of baseline RAR predicting NIV failure.
RAR, red cell distribution width-to-albumin ratio; RDW, red cell distribution width; NIV, non-invasive ventilation; ROC, receiver operating characteristic
Figure 3
Figure 3. Kaplan-Meier curve of 28-day mortality stratified by high baseline RAR (>5.43%dL/g).
RAR, red cell distribution width-to-albumin ratio
See this image and copyright information in PMC

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