RDW-to-Albumin Ratio as a Simple Biomarker for Early Mortality Risk After LVAD Implantation.

Background and

Objectives

Early risk stratification remains challenging in patients undergoing left ventricular assist device (LVAD) implantation. Red cell distribution width (RDW) and serum albumin reflect systemic stress and nutritional reserve; their ratio (RDW-to-albumin ratio, RAR) may provide a simple preoperative index. We evaluated whether preoperative RAR is associated with early mortality after LVAD implantation. Materials and

Methods

We conducted a retrospective cohort study of LVAD recipients (2019-2025). RAR was calculated as RDW (%) divided by albumin (g/dL) from preoperative blood tests obtained 24-48 h before surgery. The primary endpoint was in-hospital mortality. The secondary endpoint was 90-day survival. In-hospital mortality was analyzed using logistic regression with parsimonious adjustment for INTERMACS high-risk status (profiles 1-2 vs. 3-7); penalized regression was used to reduce small-sample bias. Discrimination was assessed using receiver operating characteristic (ROC) analysis. Ninety-day survival was evaluated using Cox proportional hazards models.

Results

Forty-seven patients were included (37 survivors; 10 in-hospital deaths). Higher RAR was associated with increased odds of in-hospital mortality and remained significant after adjustment for INTERMACS high-risk status (OR 1.68, 95% CI 1.04-2.90). INTERMACS high-risk status was strongly associated with in-hospital mortality (OR 17.89, 95% CI 3.19-138.07). RAR demonstrated good discrimination for in-hospital mortality (AUC 0.801, 95% CI 0.648-0.955). For 90-day survival, RAR showed a borderline association in unadjusted analysis (HR 1.28, 95% CI 0.98-1.68) and was not significant after adjustment (HR 1.20, 95% CI 0.89-1.63).

Conclusions

In this small single-center cohort, preoperative RAR was independently associated with in-hospital mortality after LVAD implantation. These findings should be considered hypothesis-generating and require external validation.