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Purpose <p>This study aimed to evaluate the diagnostic value of red blood cell distribution width-to-albumin ratio (RAR), a biomarker integrating hematological and metabolic information, for COVID-19 pneumonia.</p> Methods <p>This retrospective study analyzed clinical data from 2,205 patients with COVID-19. RAR values were calculated as the ratio of red blood cell distribution width (RDW) to serum albumin concentration. Diagnostic performance of RAR in COVID-19 pneumonia was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal cut-off was determined. Mediation analysis was conducted to examine the role of chronological age in the association between RAR and COVID-19 pneumonia risk.</p> Results <p>Among COVID-19 patients, RAR demonstrated strong diagnostic performance for COVID-19 pneumonia, with area under the curve (AUC) of 0.769 [95% confidence interval (CI): 0.747–0.791], sensitivity of 76.8%, and specificity of 65.3% at the optimal cut-off value of 0.154. Its diagnostic utility likely stems from simultaneously reflecting hematopoietic dysfunction (elevated RDW) and systemic metabolic imbalance (hypoalbuminemia). Mediation analysis indicated that chronological age accounted for 14.16% of the association between elevated RAR and COVID-19 pneumonia risk (β = 0.1139, 95%CI: 0.0802–0.1524).</p> Conclusion <p>RAR represents a promising biomarker for the early detection and risk stratification of COVID-19 pneumonia. By simultaneously capturing hematologic and metabolic disturbances, RAR provides a more comprehensive reflection of disease severity. The observed age-mediation effect suggests that elderly individuals with elevated RAR may face heightened risk, warranting enhanced clinical monitoring or prioritized intervention.</p>

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The prognostic value of red cell distribution width-to-albumin ratio (RAR) in COVID-19 pneumonia: implications for early diagnosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月10日

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  • Heming Huang,
  • Wei Xu,
  • Yang Wang,
  • Yanjia Shi,
  • Sijing Tang,
  • Jiarui Pei,
  • Yun Zhou,
  • Liya Zhang,
  • Ying Xue

摘要

Purpose

This study aimed to evaluate the diagnostic value of red blood cell distribution width-to-albumin ratio (RAR), a biomarker integrating hematological and metabolic information, for COVID-19 pneumonia.

Methods

This retrospective study analyzed clinical data from 2,205 patients with COVID-19. RAR values were calculated as the ratio of red blood cell distribution width (RDW) to serum albumin concentration. Diagnostic performance of RAR in COVID-19 pneumonia was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal cut-off was determined. Mediation analysis was conducted to examine the role of chronological age in the association between RAR and COVID-19 pneumonia risk.

Results

Among COVID-19 patients, RAR demonstrated strong diagnostic performance for COVID-19 pneumonia, with area under the curve (AUC) of 0.769 [95% confidence interval (CI): 0.747–0.791], sensitivity of 76.8%, and specificity of 65.3% at the optimal cut-off value of 0.154. Its diagnostic utility likely stems from simultaneously reflecting hematopoietic dysfunction (elevated RDW) and systemic metabolic imbalance (hypoalbuminemia). Mediation analysis indicated that chronological age accounted for 14.16% of the association between elevated RAR and COVID-19 pneumonia risk (β = 0.1139, 95%CI: 0.0802–0.1524).

Conclusion

RAR represents a promising biomarker for the early detection and risk stratification of COVID-19 pneumonia. By simultaneously capturing hematologic and metabolic disturbances, RAR provides a more comprehensive reflection of disease severity. The observed age-mediation effect suggests that elderly individuals with elevated RAR may face heightened risk, warranting enhanced clinical monitoring or prioritized intervention.