ASSESSING THE PROGNOSTIC VALUE OF THE HEMOGLOBIN-TO-RED CELL DISTRIBUTION WIDTH RATIO IN EMERGENCY DEPARTMENT PATIENTS WITH ACUTE CORONARY SYNDROME

Objective: Acute coronary syndrome (ACS) is a critical condition requiring rapid evaluation in the emergency department. The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a potential prognostic biomarker, reflecting the combined effects of hemoglobin and red cell distribution width. This study aims to evaluate the prognostic value of HRR in patients presenting to the emergency department with ACS. Material and Methods: A retrospective cohort study was conducted at a single center, involving adult patients who were diagnosed with acute coronary syndrome upon presentation to the emergency department. HRR was calculated as the ratio of hemoglobin to red cell distribution width, and its association with 30-day cardiac mortality (CM), all-cause mortality (ACM), and major adverse cardiovascular events (MACE) was analyzed using Receiver Operating Characteristics (ROC) curve analysis. Results: The study included 688 patients, with a mean age of 61.9±12.3 years and 57% males. Lower HRR was significantly associated with higher 30-day CM, ACM, and MACE rates. ROC curve analysis showed HRR had acceptable discriminatory power with AUC values of 0.764 for 30-day CM, 0.718 for 30-day ACM, and 0.739 for 30-day MACE. An HRR cut-off value of 0.9 was determined, with sensitivities of 87.8%, 90.2%,and 88.7%, and specificities of 47.6%, 48.4%, and 48.9% for CM, ACM, and MACE, respectively. Conclusion: HRR is a useful prognostic marker for 30-day outcomes in ACS patients. Its easy accessibility and rapid availability makes it a practical tool for risk stratification in the emergency department.