---
title: "RAR-modified SOFA score predicts 28-day mortality in acute pancreatitis: MIMIC‑IV retrospective st"
id: "plos-one-3-correlation-of-red-cell-distribution-width-to-albumin-ratio-combined-with-sofa"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-3-correlation-of-red-cell-distribution-width-to-albumin-ratio-combined-with-sofa"
content_type: "clinical_feed_article"
specialty: "Gastroenterology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579"
published_at: "2026-09-01T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# RAR-modified SOFA score predicts 28-day mortality in acute pancreatitis: MIMIC‑IV retrospective st
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-3-correlation-of-red-cell-distribution-width-to-albumin-ratio-combined-with-sofa
- **Specialty:** [Gastroenterology](https://medichelpline.com/clinical-feed/gastroenterology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579)
- **Published At:** 2026-09-01T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This retrospective study used the MIMIC‑IV (v3.1) database to evaluate whether combining the **red cell distribution width‑to‑albumin ratio (RAR)** with the **SOFA** score improves prediction of **28‑day all‑cause mortality** in ICU patients with acute pancreatitis (AP). - From 2008–2022 MIMIC‑IV admissions, 702 adult ICU patients with AP met inclusion criteria after excluding repeat ICU admissions, ICU stay <24 hours, and missing RDW, albumin, or SOFA data. - The primary analysis used univariate and multivariate Cox regression to test the RAR‑modified SOFA score as an independent risk factor for 28‑day mortality. - The optimal cutoff for the combined indicator was identified using the Youden index; Kaplan‑Meier survival curves compared high and low groups defined by that cutoff. - ROC curve analysis showed the **RAR‑modified SOFA score** had better discriminatory performance than RAR or SOFA alone for predicting 28‑day mortality. - A RAR‑modified SOFA score threshold of **12.69** separated higher from lower risk: the high‑value group (≥12.69) had significantly higher 28‑day mortality by K‑M analysis. - Subgroup analyses were conducted to assess robustness across different patient populations; the RAR‑modified SOFA score remained an independent predictor in adjusted models. - The authors conclude that integrating RAR (a marker of inflammation/nutritional status) with the organ dysfunction–focused SOFA score yields a simple, more accurate prognostic indicator for short‑term mortality in AP ICU patients. - Data source, cohort selection process, statistical approaches (Cox regression, ROC, Youden index, Kaplan‑Meier), and the key cutoff value are reported in the source. No additional external data or recommendations were provided.
## Clinical Analysis & Structured Key Points
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Correlation of red cell distribution width-to-albumin ratio combined with SOFA score with 28-day all-cause mortality in patients with acute pancreatitis: A retrospective study based on the MIMIC-IV database * Jianlei Chen, Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0007-5316-856X ](https://orcid.org/0009-0007-5316-856X "ORCID Registry") ⨯ * Hua Li, Roles Formal analysis, Investigation, Methodology, Writing – review & editing Current address: Yanji Center for Disease Control and Prevention, Yanji, Jilin, China Affiliation Yanji Center for Disease Control and Prevention, Yanji, Jilin, China ⨯ * Hongfei Wang, Roles Formal analysis, Investigation, Methodology Current address: 7th Department of Surgery, Puning People’s Hospital, Puning, Guangdong, China Affiliation 7th Department of Surgery, Puning People’s Hospital, Puning, Guangdong, China ⨯ * Zhiqiang He, Roles Formal analysis, Investigation, Methodology Current address: Department of Breast and Thyroid Surgery, Meihe Hospital the First Hospital of Jilin University (Meihekou Central Hospital), Changchun, Jilin, China Affiliation Department of Breast and Thyroid Surgery, Meihe Hospital the First Hospital of Jilin University (Meihekou Central Hospital), Changchun, Jilin, China ⨯ * Jingzhao Yin, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Songsong Yu, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Tianyu Wu, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Xiaopeng Guan, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Bowen Zheng, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Depei Kong, Roles Formal analysis, Investigation, Methodology Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ * Hao Li Roles Conceptualization, Project administration, Resources, Writing – review & editing * E-mail: lih@ybu.edu.cn (HL) Current address: Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China Affiliation Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, Jilin, China ⨯ # Correlation of red cell distribution width-to-albumin ratio combined with SOFA score with 28-day all-cause mortality in patients with acute pancreatitis: A retrospective study based on the MIMIC-IV database * Jianlei Chen, * Hua Li, * Hongfei Wang, * Zhiqiang He, * Jingzhao Yin, * Songsong Yu, * Tianyu Wu, * Xiaopeng Guan, * Bowen Zheng, * Depei Kong ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 1, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0357579) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357579) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357579) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0357579) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#abstract0) * [1. Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec005) * [2. Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec006) * [3. Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec013) * [4. Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec018) * [5. Conclusions](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec019) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#sec020) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357579) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579) ## Abstract ### Objectives The objective of this study is to evaluate the effectiveness of the red cell distribution width-to-albumin ratio (RAR) in conjunction with the Sequential Organ Failure Assessment (SOFA) score for predicting 28-day all-cause mortality in patients with acute pancreatitis (AP). ### Methods In this study, we conducted a retrospective analysis of clinical data from 702 patients with AP sourced from the MIMIC-IV (v3.1) database. We evaluated the relationship between the RAR-modified SOFA score and 28-day all-cause mortality using both univariate and multivariate Cox regression analyses. Furthermore, the optimal cutoff value was determined using the Youden index, and the predictive performance of the combined indicator was evaluated through Receiver Operating Characteristic (ROC) curves and Kaplan-Meier (K-M) survival analysis. Finally, we examined the robustness of our findings across different populations through subgroup analyses. ### Results A total of 702 patients with AP admitted to the Intensive Care Unit (ICU) were included in this study, and their 28-day all-cause mortality was analyzed. Both univariate and multivariate Cox regression analyses indicated that the RAR-modified SOFA score served as an independent risk factor for 28-day all-cause mortality in ICU patients with AP. ROC curve analysis demonstrated that the RAR-modified SOFA score exhibited superior predictive ability compared to other scoring systems, including RAR and SOFA alone. Additionally, K-M survival curve analysis revealed that the mortality rate was significantly higher in the high-value group (RAR-modified SOFA score ≥ 12.69) compared to the low-value group (RAR-modified SOFA score . **Funding:** The author(s) received no specific funding for this work. **Competing interests:** No authors have competing interests. ## 1. Introduction Acute pancreatitis (AP) is associated with serious health consequences and potentially life-threatening effects. It is characterized by epigastric pain, abdominal distension, nausea, and vomiting [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref001)]. As a prevalent acute abdominal condition complicated by a systemic inflammatory response and persistent organ failure, AP can lead to tissue and organ damage through mechanisms involving oxidative stress and the release of pancreatic enzymes [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref002)]. Approximately 20% of patients with AP develop severe acute pancreatitis (SAP), with a mortality rate as high as 40% [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref003),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref004)]. Early and accurate assessment of disease severity is therefore essential for optimizing treatment strategies and improving survival. The aim of this study was to evaluate the effectiveness of the red cell distribution width-to-albumin ratio (RAR) in conjunction with the Sequential Organ Failure Assessment (SOFA) score for predicting 28-day all-cause mortality in patients with AP. We hypothesized that combining RAR with SOFA would yield superior predictive performance compared to either indicator alone. Red cell distribution width (RDW) is a hematological index reflecting the heterogeneity of red blood cell volume, which is strongly associated with oxidative stress, inflammatory responses, and nutritional status. Similarly, albumin is a critical nutritional marker that declines during malnutrition or inflammatory stimuli. The RAR has emerged as a promising composite biomarker that mitigates physiological fluctuations to better predict disease severity in acute conditions. Meanwhile, the SOFA score is extensively utilized to evaluate multiorgan dysfunction in critically ill patients, demonstrating high specificity in predicting mortality for severe acute pancreatitis. Given that RAR reflects systemic inflammation and nutritional status while SOFA captures multiorgan dysfunction. In recent years, researchers have investigated the prognostic significance of composite biomarkers such as the neutrophil/lymphocyte ratio [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref005)], platelet/lymphocyte ratio [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref006)], lactate/albumin ratio [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref007)], and C-reactive protein/albumin ratio [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref008)]. They have sought to integrate traditional scoring systems to enhance the predictive validity and stability for AP. Previous studies have indicated that both the RAR and SOFA scoring systems possess substantial advantages in predicting outcomes in AP [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref009)]. However, to date, no research has explored the combination of the RAR and SOFA scoring systems to assess the prognosis of AP patients. Our results are consistent with and extend previous studies on RAR in AP. Donmez et al. reported that RAR is a useful marker for identifying biliary pancreatitis [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref010)], and Wang et al. demonstrated its predictive capability for SAP [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref011)]. A recent study by Chen et al. showed a nonlinear relationship between RAR and long-term mortality in AP [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref012)]. Regarding combination approaches, Ren et al. proposed that RAR combined with the Bedside Index for Severity in Acute Pancreatitis (BISAP) improves severity prediction [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref013)], and Pan et al. developed a nomogram incorporating RAR for 30-day mortality prediction [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref014)]. However, to our knowledge, no study has yet integrated RAR with the SOFA score, a widely used organ failure assessment tool to predict short-term mortality in AP. The SOFA score has shown high specificity in SAP mortality prediction [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref015)], but its AUC in AP is modest. By combining RAR with SOFA, the present study provides a novel, easy-to-use prognostic indicator for clinical practice. ## 2. Methods ### 2.1 Database introduction The data utilized in this study were retrieved from the MIMIC-IV (v3.1) database, a large, publicly available dataset maintained by the Laboratory of Computational Physiology at the Massachusetts Institute of Technology ( ). This database contains detailed information on patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center between 2008 and 2022 [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone.0357579.ref016)]. To access the database, the study’s first author, Jianlei Chen, successfully completed the Collaborative Institutional Training Initiative course and passed the required examinations, including “Conflict of Interest” and “Data or Sample Study Only” (ID: 67992428). ### 2.2 Population selection criteria The MIMIC-IV (v3.1) database recorded a total of 546028 admissions from 2008 to 2022, with 94458 of these patients admitted to the ICU. From this cohort, we identified 4930 patients with AP using the International Classification of Diseases, 9th Revision (ICD-9) code 577.0 and International Classification of Diseases, 10th Revision (ICD-10) codes K85-K85.92. Among these, 1280 patients with AP were admitted to the ICU. After a rigorous screening process, we excluded patients based on the following criteria: (1) individuals younger than 18 years at the time of their first admission; (2) patients with AP who were admitted to the ICU multiple times, retaining only data from their first admission; (3) those who remained in the ICU for less than 24 hours; and (4) patients admitted to the ICU without corresponding data on RDW, albumin levels, and SOFA scores. Consequently, the final number of patients included in this study was 702 ([Fig 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357579#pone-0357579-g001)). [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=in
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