The hemoglobin-to-red cell distribution width ratio (HRR) has been proposed as a prognostic biomarker in multiple clinical settings. Its role in traumatic brain injury (TBI) requiring intensive care unit (ICU) admission was unclear. This retrospective study aimed to evaluate whether admission HRR is associated with clinical outcomes—specifically in-hospital mortality and prolonged hospital length of stay (LOS)—in adult patients with traffic-related TBI admitted to a Level I trauma center ICU.
Investigators conducted a retrospective review of medical records from a single Level I trauma center in Taiwan for the years 2016–2017. The analysis included adult patients with traffic-related TBI who were admitted to the ICU and had a Head and Neck Abbreviated Injury Scale (AIS) score ≥ 3. A total of 105 patients met inclusion criteria and were included in the analysis.
HRR was calculated from routinely obtained hematologic parameters on admission (hemoglobin and red cell distribution width). The cohort median HRR value was 1.057, and this value was used as the cutoff to dichotomize patients into a low-HRR group and a high-HRR group for comparative and outcome analyses.
The study predefined two primary outcomes: in-hospital mortality and prolonged hospital LOS. The abstract does not provide the specific numeric threshold used to define "prolonged" LOS, nor does it report the exact LOS distributions; those details were not reported in the abstract.
Compared with the high-HRR group, patients in the low-HRR group were older, had a higher proportion of females, and exhibited a higher prevalence of diabetes. Additional demographic, injury-severity, physiologic, or comorbidity data beyond these reported differences were not detailed in the abstract.
After adjustment for clinical variables, the dichotomized analysis showed that the high-HRR group had significantly lower odds of experiencing a prolonged hospital LOS than the low-HRR group. In contrast, HRR was not significantly associated with in-hospital mortality after adjustment. The abstract reports the presence of multivariable adjustment but does not list the specific covariates, adjusted effect estimates, confidence intervals, p-values, or model performance metrics in the abstract text.
In this single-center retrospective cohort of ICU-admitted, traffic-related TBI patients, a higher admission HRR was independently associated with a decreased likelihood of prolonged hospitalization. Because HRR derives from routine complete blood count parameters, it is an accessible biomarker that could potentially aid early risk stratification for expected hospital LOS in TBI patients.
However, HRR did not predict in-hospital mortality in the adjusted models reported in the abstract. Therefore, while HRR may inform expectations about LOS, it should not be interpreted from this report alone as a predictor of survival.
The published abstract summarizes core findings but omits several details important for interpretation and external application: the specific LOS cutoff used to define "prolonged," the full list of covariates included in adjusted models, numerical effect sizes (odds ratios, confidence intervals), statistical methods and model diagnostics, and whether sensitivity or subgroup analyses were performed. These items were not reported in the abstract and would require review of the full text for confirmation.
Additionally, as a retrospective single-center study confined to traffic-related TBI cases from 2016–2017 at one hospital in Taiwan, generalizability may be limited; the abstract does not report external validation.
Among 105 adult patients with traffic-related TBI admitted to the ICU, a higher admission hemoglobin-to-RDW ratio (HRR)—above the cohort median of 1.057—was independently associated with lower odds of prolonged hospital length of stay after adjustment for clinical variables. HRR was not significantly associated with in-hospital mortality after adjustment according to the abstract. Further details and external validation are necessary before HRR can be recommended for routine prognostic use in ICU TBI populations.