Joint analysis of hemoglobin-to-RDW and creatinine-to-albumin ratios for mortality prediction in critical heart failure

Hemoglobin-to-red cell distribution width ratio (HRR) and creatinine-to-albumin ratio (CAR) are simple and easily obtainable biomarkers reflecting anemia/inflammation and renal and nutritional status, respectively. We investigated whether these markers predict mortality in intensive care unit (ICU) patients with heart failure (HF). In a retrospective analysis of 31,454 ICU cases from three critical care databases (MIMIC-IV, MIMIC-III, eICU-CRD) and an independent hospital cohort, Cox regression models assessed associations with 28-day all-cause mortality (primary outcome) and 90-day, 180-day, and 1-year mortality. Higher HRR was independently associated with lower 28-day mortality, whereas higher CAR predicted higher 28-day mortality risk. These associations remained consistent at 90-day, 180-day, and 1-year follow-up. Patients with combined low HRR and high CAR had the greatest 28-day mortality risk. HRR and CAR thus serve as independent predictors of short-term mortality in ICU patients with HF, and their joint assessment may improve early risk stratification and management.