Association of red blood cell distribution width to albumin ratio with prognosis in stroke patients

Abstract

Aim: The authors investigated the association of red blood cell distribution width to albumin ratio (RAR) with prognosis and severity in acute ischemic stroke (AIS). Methods: One hundred twenty-seven patients with AIS were prospectively analyzed. The NIH Stroke Scale was used to determine stroke severity. RAR was compared between severe and nonsevere patients. Results: RAR was significantly higher in severe compared with nonsevere patients (p < 0.001). According to receiver operating characteristic analysis, RAR alone predicted mortality better than red blood cell distribution width and albumin (area under the curve: 0.933, 0.911, 0.870, respectively). Additionally, RAR was significantly correlated with NIH Stroke Scale score (p < 0.001). Conclusion: High RAR measured at presentation is a feasible index for prognosis and severity stratification in AIS.

Summary points

• Red blood cell distribution width to albumin ratio (RAR) was significantly higher in severely ill patients who did not survive, were hospitalized in the intensive care unit and received mechanical ventilation support compared with nonsevere patients (p < 0.001 for all).

• According to receiver operating characteristic analysis, RAR alone predicted mortality better than red blood cell distribution width and albumin, and the combination of RAR with NIH Stroke Scale (NIHSS) score achieved the highest predictive value (area under the curve: 0.933, 0.911, 0.870, 0.953, respectively).

• A RAR cutoff value >0.397 yielded a sensitivity of 94.7% and a specificity of 74.1% (area under the curve: 0.933; p < 0.001).

• According to Spearman correlation analysis, RAR levels were significantly positively correlated with NIHSS score (p < 0.001).

• It was observed that as RAR levels increased, NIHSS score rose and Glasgow Coma Scale score decreased.

Keywords: :

• albumin
• biomarkers
• emergency medicine
• inflammation
• ischemic stroke
• mortality
• NIHSS
• prognosis
• RDW to albumin ratio
• red blood cell distribution width

Author contributions

Concept, design and writing of manuscript: A Eyiol, B Ertekin; acquisition of data: A Eyiol, B Ertekin; analysis: A Eyiol; drafting: A Eyiol; critical revision: A Eyiol, B Ertekin.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval (Necmettin Erbakan University Faculty of Medicine Local Ethics Committee [date: 18 November 18 2022 and number: 2022/4048[11934]) and have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Acknowledgments

The authors would like to thank Fatih İkiz for his contributions.