{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:49:17Z","timestamp":1777866557720,"version":"3.51.4"},"reference-count":18,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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\u20132025). RAR was calculated as RDW (%) divided by albumin (g\/dL) from preoperative blood tests obtained 24\u201348 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\u20132 vs. 3\u20137); 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\u20132.90). INTERMACS high-risk status was strongly associated with in-hospital mortality (OR 17.89, 95% CI 3.19\u2013138.07). RAR demonstrated good discrimination for in-hospital mortality (AUC 0.801, 95% CI 0.648\u20130.955). For 90-day survival, RAR showed a borderline association in unadjusted analysis (HR 1.28, 95% CI 0.98\u20131.68) and was not significant after adjustment (HR 1.20, 95% CI 0.89\u20131.63). 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.<\/jats:p>","DOI":"10.3390\/medicina62050853","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:03:47Z","timestamp":1777536227000},"page":"853","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["RDW-to-Albumin Ratio as a Simple Biomarker for Early Mortality Risk After LVAD Implantation"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3813-922X","authenticated-orcid":false,"given":"\u0130brahim","family":"Demir","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilge","family":"Ecemi\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fe","family":"Zorba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3856-8975","authenticated-orcid":false,"given":"Selinsu","family":"G\u00fcle\u015fce","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahya","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130brahim O\u011fuz","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Korhan","family":"Erkanl\u0131","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul 34214, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1097\/MAT.0000000000000431","article-title":"Associations of Preimplant Red Blood Cell Distribution Width with Clinical Outcomes Among Individuals with Left Ventricular Assist Devices","volume":"62","author":"Miller","year":"2016","journal-title":"ASAIO J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.healun.2022.05.015","article-title":"Clinical myocardial recovery in advanced heart failure with long term left ventricular assist device support","volume":"41","author":"Kanwar","year":"2022","journal-title":"J. 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Aging"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/853\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:52:14Z","timestamp":1777539134000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050853"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050853","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}