Impact of the red blood cell distribution width-to-albumin ratio on neurological outcomes in cardiac arrest patients.

OBJECTIVES: Brain injury remains the leading cause of mortality and morbidity among patients who experience cardiac arrest and cardiopulmonary resuscitation (CA/CPR). There is an urgent need to explore simpler and cheaper biomarkers to predict post-CA neurological outcomes. The red blood cell distribution width-to-albumin ratio (RA) has been used to assess inflammatory responses and prognosis in several diseases. This study was conducted to assess the correlation between RA levels and post-CA neurological outcomes, and to determine the value of RA in predicting neurological function after CA/CPR. METHODS: We conducted a retrospective observational study on out-of-hospital cardiac arrest (OHCA) cases presenting to our hospital's emergency department between January 2023 and April 2026. All patients were divided into cohorts with good or poor neurological outcomes according to cerebral performance categories (CPCs). Cox regression models were used to estimate the correlation between RA and neurological outcomes. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the ability of RA to predict neurological outcomes in patients after CA/CPR. RESULTS: In total, 80 patients were involved, of whom 10 survived to hospital discharge with good neurological function (CPC ≤ 2), while the remaining subjects showed poor neurological function (CPC ≥ 3). RA levels were significantly higher in patients with poor neurological outcomes than in those with good outcomes. The AUC for the RA was 0.90, indicating excellent predictive accuracy. The RA values were independently associated with poor neurological outcomes following CA/CPR, even after adjusting for potential confounding factors. CONCLUSION: We found that RA is associated with post-CA neurological outcomes, and higher RA levels could serve as a predictor of worse neurological outcomes in patients who undergo CPR after experiencing CA.