ArticleFrontiers in cardiovascular medicine2026
The association between the red blood cell distribution width-to-albumin ratio and in-hospital mortality in cardiac arrest patients: an analysis of the eICU database.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cardiac arrest triggers systemic ischemia-reperfusion injury, which initiates a cascade of inflammatory responses that particularly damage cerebral and myocardial tissues. Although the red blood cell distribution width-to-albumin ratio (RAR) has been extensively studied in various cardiovascular conditions, its prognostic value for predicting in-hospital mortality in cardiac arrest patients remains unclear. This study aimed to examine the association between RAR levels and in-hospital mortality risk in post-cardiac arrest patients. Methods: We enrolled 2,508 cardiac arrest patients admitted to intensive care units (ICUs) from the eICU Collaborative Research Database (eICU-CRD). Patients were categorized into tertiles based on RAR levels. The primary endpoint was in-hospital mortality. We employed logistic regression models, restricted cubic splines (RCS), and subgroup analyses to evaluate the association between RAR and mortality. Results: Among the 2,508 eligible patients (mean age: 63.1 years; 58.5% male), a nonlinear relationship between RAR and in-hospital mortality was identified using restricted cubic spline and threshold analyses. The association of RAR with in-hospital mortality was stronger below the RAR threshold of 5.354; at or above this cutoff, the association remained statistically significant but was markedly attenuated. Each one-unit increase in RAR was independently associated with higher in-hospital mortality risk after full adjustment (adjusted odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.10-1.22). Consistent with the continuous trend analysis, patients in the highest RAR tertile had a significantly higher mortality risk compared with those in the lowest tertile ( Conclusion: In this retrospective cohort study, elevated RAR was independently associated with higher in-hospital mortality in cardiac arrest patients with a nonlinear threshold effect. While this positive association was directionally consistent across subgroups, its magnitude was significantly modified by hypertension. As a low-cost routine biomarker, RAR showed significant prognostic relevance; however, its modest predictive performance and negligible incremental value over albumin limit its clinical utility, requiring prospective external validation.
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