Higher red blood cell distribution width-to-albumin ratio (RA) levels were independently associated with poor neurological outcomes following cardiac arrest/CPR, with an AUC of 0.90 indicating excellent predictive accuracy.
Key Findings
Results
RA levels were significantly higher in cardiac arrest patients with poor neurological outcomes than in those with good neurological outcomes.
80 total patients were included in the retrospective observational study
10 patients survived to hospital discharge with good neurological function (CPC ≤ 2)
70 patients showed poor neurological function (CPC ≥ 3)
The study was conducted on out-of-hospital cardiac arrest (OHCA) cases presenting to the emergency department between January 2023 and April 2026
Results
The RA demonstrated excellent predictive accuracy for neurological outcomes after cardiac arrest, with an AUC of 0.90.
The area under the receiver operating characteristic curve (AUC) for RA was 0.90
The AUC was described as indicating 'excellent predictive accuracy'
Neurological outcomes were classified using cerebral performance categories (CPCs)
Results
RA values were independently associated with poor neurological outcomes following CA/CPR after adjusting for potential confounding factors.
Cox regression models were used to estimate the correlation between RA and neurological outcomes
The association remained significant even after adjusting for potential confounding factors
The study design was retrospective and observational
Background
The red blood cell distribution width-to-albumin ratio (RA) was evaluated as a biomarker for post-cardiac arrest neurological prognosis based on its known role in assessing inflammatory responses.
Brain injury is identified as the leading cause of mortality and morbidity among patients who experience cardiac arrest and CPR
RA has previously been used to assess inflammatory responses and prognosis in several diseases
The study sought simpler and cheaper biomarkers to predict post-CA neurological outcomes
The study focused specifically on out-of-hospital cardiac arrest (OHCA) patients
What This Means
This research suggests that a simple blood test ratio — the red blood cell distribution width divided by albumin level (called the 'RA ratio') — may help predict how well the brain recovers after cardiac arrest. The study followed 80 patients who experienced out-of-hospital cardiac arrest and received CPR. Only 10 of these patients survived with good brain function, while the rest had poor neurological outcomes. Patients with poor brain recovery had significantly higher RA ratio values than those who recovered well.
The RA ratio performed impressively as a predictor, achieving an area under the curve (AUC) of 0.90, which is considered excellent — meaning it was quite accurate at distinguishing patients who would have poor neurological outcomes from those who would recover better. Importantly, this association held up even after the researchers statistically accounted for other factors that could have influenced the results.
This research suggests that the RA ratio, which can be calculated from routine blood tests already commonly performed in hospitals, could offer a relatively simple and inexpensive tool to help clinicians anticipate neurological recovery after cardiac arrest. However, the study was small (80 patients), conducted at a single hospital, and was retrospective in design, which means larger and more rigorous studies would be needed to confirm these findings before the RA ratio could be widely adopted in clinical practice.
Yang X, Wang H, Wang F, Peng F. (2026). Impact of the red blood cell distribution width-to-albumin ratio on neurological outcomes in cardiac arrest patients.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1732315