Abstract
BACKGROUND: 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.