Prognostic value of the red blood cell distribution width-to-albumin ratio in alcohol-related sarcopenia

Abstract Chronic alcohol consumption is associated with sarcopenia, a metabolic disorder characterized by progressive loss of muscle mass and function. The red blood cell distribution width-to-albumin ratio (RAR) has emerged as a composite biomarker reflecting inflammation, oxidative stress, and nutritional status. This study aimed to evaluate the prognostic value of RAR in patients with alcohol use disorder and sarcopenia. We conducted a prospective observational study including 231 patients with chronic alcohol consumption (mean intake 200 g/day) recruited at a tertiary hospital between 2008 and 2025. Clinical, analytical, and body composition variables were assessed using densitometry and handgrip strength. Probable sarcopenia was defined according to EWGSOP2 criteria based on low muscle strength. Cox and logistic regression models and ROC curve analysis were performed. RAR was positively associated with liver dysfunction and inflammatory markers, and inversely correlated with appendicular lean mass and handgrip strength. In patients with probable sarcopenia, RAR was independently associated with 12-month mortality (hazard ratio 1.67; 95% confidence interval 1.32–2.11; p < 0.001). The predictive capacity of RAR was high (AUC 0.81; 95% CI 0.67–0.94). In conclusion, RAR is a simple, low-cost, and independent prognostic biomarker that integrates inflammatory and nutritional status in patients with alcohol use disorder and sarcopenia.