The Red Blood Cell Distribution Width to Albumin Ratio Is Associated with in Hospital Mortality and Adverse Outcome in Elderly Chinese Patients with Gastrointestinal Bleeding

Fan Zhang,1 Jie Chen,2 Yu-Jun Xiong,1 Hua Wang,3 Qing-Feng Luo1 1Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Radiology, Xinyang Third People’s Hospital, Xinyang, Henan Province, People’s Republic of China; 3Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Hua Wang, Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China, Email [email protected]: Gastrointestinal bleeding (GIB) in elderly patients is a common and life-threatening condition, often complicated by comorbidities. The ratio of red blood cell distribution width to albumin (RAR) has recently been proposed as a prognostic marker in various diseases, but its role in predicting adverse outcomes in GIB patients remains unclear.Methods: A total of 51,824 aged 65 years or older patients were initially screened for inclusion in the study. After excluding those lost to follow-up, with missing vital information during the screening period (n = 50,423), 1401 hospitalized patients with GIB in Beijing Hospital (2013– 2019) were included. Restricted cubic spline modeling and logistic regression analyses assessed the relationships between RAR, adverse outcomes, and in hospital mortality.Results: Among the 1, 401 patients, 648 experienced adverse outcomes, and 427 patients died during hospitalization. Higher RAR was significantly associated with an increased risk of both in-hospital mortality and adverse outcomes, even after adjusting for age, sex, education level, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), cancer, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), white blood cell count (WBC), estimated glomerular filtration rate (eGFR), hemoglobin, heart failure, blood urea nitrogen (BUN), and heart rate.Conclusion: RAR is a novel and independent predictor of mortality and adverse outcomes in elderly patients with GIB. Its simplicity and cost-effectiveness make it a valuable tool for identifying high-risk patients. Further studies in larger, multicenter cohorts are needed to confirm these findings and evaluate the clinical benefits of RAR-based interventions.Keywords: gastrointestinal bleeding, elderly, RAR, mortality, adverse outcomes