Association between red cell distribution width to albumin ratio and 28‑day mortality in older patients with sepsis: A retrospective cohort study

Red blood cell distribution width to albumin ratio (RAR) is a novel biomarker and its prognostic effect on critically ill patients with sepsis has not been extensively investigated. The objective of this study was to investigate the association between RAR and prognosis in older patients with sepsis. We performed a retrospective cohort study utilizing the eICU Collaborative Research Database to examine the relationship between the RAR and patient outcomes in sepsis cases. The primary endpoint was all-cause mortality within 28 days of intensive care unit admission. To explore this association, we employed multivariate regression analysis and conducted subgroup analyses. Additionally, receiver operating characteristic curves and Kaplan-Meier survival analysis were utilized to assess prognostic value and survival differences, respectively. The study included 17,321 eligible patients. It was observed that the median of RAR was notably higher in patients who did not survive compared to those who did at the 28-day mark. Participants were categorized into 3 groups based on their RAR values, revealing a significantly increased risk of 28-day mortality in the group with elevated RAR. The association between RAR and 28-day mortality risk appeared potentially nonlinear. Kaplan-Meier survival analysis indicated that those in the higher RAR group experienced increased 28-day mortality. Our study shows that RAR is significantly associated with poor clinical prognosis in sepsis. The higher RAR is an independent predictor of 28-day mortality in older patients with sepsis.