Abstract Background Red blood cell distribution width (RDW) and the RDW-to-albumin ratio (RAR) have emerged as significant prognostic markers for mortality in a wide range of diseases. However, whether RDW and RAR are associated with higher risk of mortality in patients with light chain cardiac amyloidosis (AL-CA) remains unclear. Methods Consecutive patients diagnosed with AL-CA between September 2014 and November 2023, with available data were enrolled. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate the association between RDW, RAR and the risk of all-cause mortality. Restricted cubic spline regressions were applied to estimate possible nonlinear associations. Results A total of 182 patients were included, with a mean age of 60.54 years (standard deviation SD: 10.23 years); 68 patients (37.4%) were female, 149 patients (81.9%) were in European modified Mayo 2004 stage III. The cutoff value of RDW and RAR were set at 14.47% and 0.34, respectively. Over an average follow-up period of 367 days, 98 patients (53.8%) died. Kaplan-Meier survival analysis revealed that patients with higher baseline RDW and RAR levels had significantly worse survival (log-rank test, P0.01 and P0.001, respectively). In multivariable Cox regression analysis, both log-transformed RDW and RAR remained independently associated with the primary outcome, even after full adjustment for age, gender, European modified Mayo 2004 stages, and treatment strategies (adjusted HR: 5.08, 95% CI: 1.33–19.35, P0.05; adjusted HR: 2.43, 95% CI: 1.10–5.38, P0.05).RCS analysis revealed a non-linear relationship between RDW and RAR and the increased risk of mortality in these patients. Conclusion Elevated baseline RDW and RAR are robust and independent indicator of worse prognosis in AL-CA patients and can be used to identify high-risk patients.Kaplan-Meier curves of overall survival. Restricted cubic splines.
Li et al. (Sat,) studied this question.