{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:44:27Z","timestamp":1790113467060,"version":"4.0.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The association between red blood cell distribution width-to-albumin (RDW\/ALB) ratio (RAR) and all-cause mortality in patients with acute pancreatitis has not been fully delineated. The purpose of this study was to investigate the impact of RAR at admission on 28-day all-cause mortality in patients with acute pancreatitis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>This investigation was conducted as a retrospective analysis utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-III database.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Participants<\/jats:title>\n<jats:p>Patients with acute pancreatitis were selected from the MIMIC-III database according to predefined eligibility criteria.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Outcome<\/jats:title>\n<jats:p>The outcome was the all-cause mortality rates within 28 days.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Results<\/jats:title>\n<jats:p>Upon screening and excluding ineligible participants, a total of 931 patients with acute pancreatitis who met the inclusion criteria were analyzed. The overall mortality at 28 days was 11.71%. The receiver operating characteristic (ROC) analysis indicated that RAR had a moderate predictive value for all-cause mortality at 28 days, with an area under the curve (AUC) of 0.669 (95%CI, 0.617\u20130.720; p&lt;0.05), and the cutoff value was 4.39. Divide the patients into a high RAR group and a low RAR group based on the cutoff value. Kaplan-Meier survival analysis demonstrated a statistically significant increase in 28-day mortality among patients in the high RAR group compared to those in the low RAR group. Multivariate analysis indicated that potassium levels, total bilirubin, blood urea nitrogen, lactate, partial thromboplastin time, neutrophil and RAR were independently associated with the 28-day mortality. Multivariate Cox regression analysis confirmed that an elevated RAR was independently associated with increased mortality at 28 day (HR, 2.72; 95% CI, 1.64\u20134.52; p &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study demonstrated that RAR at admission functioned as a significant prognostic indicator for mortality in patients with acute pancreatitis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318873","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T18:27:41Z","timestamp":1738952861000},"page":"e0318873","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between red blood cell distribution width-to-albumin ratio at admission and all-cause mortality in patients with acute pancreatitis based on the MIMIC-III database"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-7474","authenticated-orcid":true,"given":"Qingsong","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianyi","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjun","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"issue":"2","key":"pone.0318873.ref001","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1053\/j.gastro.2021.10.017","article-title":"Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Update 2021","volume":"162","author":"AF Peery","year":"2022","journal-title":"Gastroenterology"},{"issue":"10","key":"pone.0318873.ref002","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.gastrohep.2018.06.012","article-title":"Evaluation and management of acute pancreatitis in Spain.","volume":"41","author":"F Valverde-L\u00f3pez","year":"2018","journal-title":"Gastroenterologia y hepatologia"},{"key":"pone.0318873.ref003","article-title":"Serum Lactate Is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis.","author":"Z Zeng","year":"2024","journal-title":"Digestive diseases and sciences"},{"key":"pone.0318873.ref004","article-title":"C-reactive protein\/lymphocyte ratio as a prognostic biomarker in acute pancreatitis. A cross-sectional study assessing disease severity.","author":"X Chen","year":"2024","journal-title":"International journal of surgery (London, England)"},{"issue":"1","key":"pone.0318873.ref005","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines12010106","article-title":"Ferritin and Ferritin-to-Hemoglobin Ratio as Promising Prognostic Biomarkers of Severity in Acute Pancreatitis-A Cohort Study","volume":"12","author":"MC Pavalean","year":"2024","journal-title":"Biomedicines"},{"issue":"1","key":"pone.0318873.ref006","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/ijabmr.ijabmr_286_22","article-title":"Red Cell Distribution Width and Ratio of Red Cell Distribution Width-to-Total Serum Calcium as Predictors of Outcome of Acute Pancreatitis.","volume":"13","author":"V Gupta","year":"2023","journal-title":"International journal of applied & basic medical research"},{"issue":"6","key":"pone.0318873.ref007","doi-asserted-by":"crossref","first-page":"R282","DOI":"10.1186\/cc13145","article-title":"An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock","volume":"17","author":"CH Kim","year":"2013","journal-title":"Critical care (London, England)"},{"key":"pone.0318873.ref008","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.2147\/JIR.S451769","article-title":"The Ratio of Red Blood Cell Distribution Width to Albumin as a Predictor for Rehospitalization Risk and Rehospitalization All-Cause Mortality in Middle-Aged and Elderly Survivors with Sepsis. An Ambispective ICU Cohort Study.","volume":"17","author":"Y Tan","year":"2024","journal-title":"Journal of inflammation research"},{"issue":"1","key":"pone.0318873.ref009","doi-asserted-by":"crossref","first-page":"27","DOI":"10.15537\/smj.2024.45.1.20230716","article-title":"The importance of the erythrocyte distribution width\/albumin ratio in patients with chronic obstructive pulmonary disease exacerbation.","volume":"45","author":"BZ Eraslan","year":"2024","journal-title":"Saudi medical journal"},{"key":"pone.0318873.ref010","first-page":"3591243","article-title":"Prognostic Value of the Red Blood Cell Distribution Width-to-Albumin Ratio in Critically Ill Older Patients with Acute Kidney Injury. A Retrospective Database Study.","volume":"2023","author":"L Guo","year":"2023","journal-title":"Emergency medicine international"},{"key":"pone.0318873.ref011","doi-asserted-by":"crossref","first-page":"160035","DOI":"10.1038\/sdata.2016.35","article-title":"MIMIC-III, a freely accessible critical care da ase.","volume":"3","author":"AEW Johnson","year":"2016","journal-title":"Scientific data"},{"issue":"3","key":"pone.0318873.ref012","doi-asserted-by":"crossref","first-page":"e081340","DOI":"10.1136\/bmjopen-2023-081340","article-title":"Association between haemoglobin-to-red blood cell distribution width ratio at admission and all-cause mortality in adult patients with sepsis in an intensive care unit. A secondary analysis of the MIMIC-IV database","volume":"14","author":"L Zhong","year":"2024","journal-title":"BMJ open"},{"issue":"1","key":"pone.0318873.ref013","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12872-023-03094-1","article-title":"Association between red blood cell distribution width-to-albumin ratio and prognosis of patients with acute myocardial infarction","volume":"23","author":"H Li","year":"2023","journal-title":"BMC cardiovascular disorders"},{"key":"pone.0318873.ref014","doi-asserted-by":"crossref","first-page":"6287","DOI":"10.2147\/IJGM.S328035","article-title":"Association Between Red Blood Cell Distribution Width-to-Albumin Ratio and Prognosis of Patients with Aortic Aneurysms","volume":"14","author":"J Long","year":"2021","journal-title":"International journal of general medicine"},{"issue":"10","key":"pone.0318873.ref015","first-page":"e30183","article-title":"Prognostic Significance of the Red Cell Distribution Width\/Albumin Ratio in the Prediction of the Severity of Acute Biliary Pancreatitis","volume":"14","author":"M Donmez","year":"2022","journal-title":"A Preliminary Report. Cureus"},{"issue":"2","key":"pone.0318873.ref016","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.pan.2023.12.015","article-title":"The red cell distribution width-to-albumin ratio. A simple index has high predictive accuracy for clinical outcomes in patients with acute pancreatitis.","volume":"24","author":"F Acehan","year":"2024","journal-title":"Pancreatology: official journal of the International Association of Pancreatology (IAP)"},{"issue":"1","key":"pone.0318873.ref017","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12876-023-02730-6","article-title":"Impact of comorbidities on hospital mortality in patients with acute pancreatitis. 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Are We on the Right Track of Assessing Metabolic Syndrome","volume":"28","author":"S Kim","year":"2013","journal-title":"Endocrinology and Metabolism"},{"issue":"4","key":"pone.0318873.ref021","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.ajem.2012.12.015","article-title":"Red cell distribution width as a predictor of mortality in acute pancreatitis","volume":"31","author":"K \u015eenol","year":"2013","journal-title":"The American journal of emergency medicine"},{"issue":"8","key":"pone.0318873.ref022","first-page":"e66193","article-title":"The Role of Red Cell Distribution Width (RDW), RDW\/Platelet Ratio, and Mean Platelet Volume as Prognostic Markers in Acute Pancreatitis Severity and Complications Based on the Bedside Index for Severity in Acute Pancreatitis Score","volume":"16","author":"A Jagodi\u0107 Ejubovi\u0107","year":"2024","journal-title":"Cureus"},{"issue":"Suppl 1","key":"pone.0318873.ref023","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/0736-4679(91)90592-4","article-title":"The red blood cell distribution width","volume":"9","author":"TC Evans","year":"1991","journal-title":"The Journal of emergency medicine"},{"issue":"4","key":"pone.0318873.ref024","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.semnephrol.2006.06.001","article-title":"Pathogenesis of renal anemia.","volume":"26","author":"M Nangaku","year":"2006","journal-title":"Seminars in nephrology"},{"issue":"7","key":"pone.0318873.ref025","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1097\/01.ASN.0000071514.36428.61","article-title":"Increased expression of erythropoiesis inhibiting cytokines (IFN-gamma, TNF-alpha, IL-10, and IL-13) by T cells in patients exhibiting a poor response to erythropoietin therapy","volume":"14","author":"AC Cooper","year":"2003","journal-title":"Journal of the American Society of Nephrology: JASN"},{"issue":"5","key":"pone.0318873.ref026","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jinf.2012.12.007","article-title":"Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia.","volume":"66","author":"D Viasus","year":"2013","journal-title":"The Journal of infection"},{"key":"pone.0318873.ref027","article-title":"Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis.","author":"W Hong","year":"2017","journal-title":"Canadian Journal of Gastroenterology & Hepatology"},{"issue":"3","key":"pone.0318873.ref028","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ajg.2022.06.001","article-title":"cell distribution width to serum albumin ratio as an early prognostic marker for severe acute pancreatitis. 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