The red blood cell distribution width–albumin ratio: A promising predictor of mortality in stroke patients

Abstract

Objective: Within this study we attempt to express a correlation between the mortality of stroke and stroke related infection to a novel biomarker represented by the red blood cell width–albumin levels ratio within the patient. We hypothesize that this novel biomarker could be utilized as better predictive tool for stroke associated infections. Methods: Patient data sets were obtained via the Medical Information Mart for Intensive Care Database iii V1.4 (MIMIC-iii). Data from 1480 patients were obtained to serve the testing for the RA biomarker tests. Clinical endpoints of 30-, 60-, and 365-day all-cause mortality in stroke patients were used as subgroups within the analyzed population. Estimation of hazard ratios (HR) were obtained from Cox regression models for stroke-associated infection and all-cause mortality in relation to RA values. Results: A high-RA was associated with increased mortality in ICU patients suffering from a stroke. After adjusting for age and sex, compared to the reference group (the first quartile), the high-RA group had the highest 30-day (HR, 95% CI: 1.88 (1.36, 2.58)), 90-day (HR, 95% CI: 2.12 (1.59, 2.82)), and one-year (HR, 95% CI: 2.15 (1.65, 2.80)) all-cause mortality. The RA values were independently associated with an increased risk of stroke-associated infection when adjusting for confounders. Conclusions: Our data suggest RA may be an easily accessible, reproducible, and low-cost biomarker for predicting stroke-associated infections and mortality in patients who have suffered from a stroke.