Background and Aim: The role of red cell distribution width-to albumin ratio (RAR) in predicting adverse outcomes of chronic obstructive pulmonary disease exacerbation (ECOPD) is not completely understood. Our aim is to evaluate the clinical significance of RAR in predicting ECOPD outcomes.

Methods: A hospital based cross-sectional comparative study was conducted on102 patients with ECOPD. The frequency of exacerbations, history hospitalization for ECOPD in the last year, severity of current exacerbation, hospitalization length of stay (LOS), respiratory failure, need of mechanical ventilation (MV) support, and short-term mortality and long-term mortality risk were recorded.

Results: The RAR was significantly increased in patients with frequent exacerbations, hospitalization in the last year, severe current exacerbation, respiratory failure, need of MV support, prolonged hospitalization, short-term mortality and high-risk long-term mortality. RAR was negatively correlated with spirometric-indices, PaO2, and O2 sat %, and positively correlated with hospitalization LOS, and BODE index. The RAR was a significant predictive index for frequent exacerbations (ß=1.51), hospitalizations (ß =1.41), severe current exacerbation (ß=1.75), respiratory failure (ß=3.29), need of MV support (ß=1.85), prolonged hospitalizations (ß=5.99), short-term mortality (ß =0.814), and high-risk long-term mortality (ß=3.97).

Conclusion: The RAR is a significant predictive index of adverse exacerbation outcomes in COPD as it discriminates patients with frequent exacerbations, hospitalizations, severe exacerbation, respiratory failure, need of MV support, prolonged hospitalizations, short-term mortality, and higher-risk long-term mortality. Therefore, it can be used to early recognize patients at increased risk of morbidity and mortality and to guide treatment of ECOPD patients to improve disease outcomes.