Red cell distribution width to albumin ratio and mortality in acute pulmonary thromboembolism

The red cell distribution width (RDW)/albumin ratio (RAR) has been identified as an inflammation-based prognostic biomarker. To date, its prognostic value in patients with pulmonary thromboembolism (PTE) has been investigated in only one prior study. This study aimed to assess the impact of RAR on mortality in patients with PTE. Between 2017 and 2023, patients admitted with PTE were retrospectively reviewed. Data collected included demographic information, comorbidities, clinical findings, RDW, albumin, troponin, D-dimer levels, and in-hospital as well as 30-day mortality outcomes. RAR was calculated by dividing RDW by albumin. A total of 190 patients were included in the study, of whom 83 (43.7%) were male. The mean age was 63 years (range: 23-89), and the mean RAR was 4.48% +/- 1.68% /g/dL. A positive correlation was observed between RAR and both age and troponin levels, whereas inverse correlations were noted with systolic blood pressure (sBP), diastolic blood pressure (dBP), and oxygen saturation (SpO2). Using a cut-off value of 5.294 determined by ROC analysis, patients with RAR >= 5.294 had a significantly shorter mean survival time compared to those with RAR value < 5.294 (16.310 months vs. 35.163 months; log-rank test, p<0.001). Multivariate Cox regression analysis identified malignancy (HR: 4.213, 95% CI: 1.103-16.090, p = 0.035) and RAR (HR: 1.295, 95% CI: 1.035-1.621, p = 0.024) as independent predictors of survival. In conclusion, a RAR value >= 5.294 was associated with significantly shorter survival, underscoring its potential utility as a prognostic marker in clinical practice for non-massive PTE.