Red Cell Distribution Width/Albumin Ratio as a Predictive Tool for Mortality of Patients With Burn Injuries

Measurement of Red Cell Distribution Width/Albumin Ratio as a Predictive Tool for 30-day Mortality of Patients With Burn Injuries

The aim of this study is to evaluate the prognostic utility of the red cell distribution width/albumin ratio (RAR), measured within 24 hours of hospital admission, in predicting 30-day mortality among patients with burn injuries.

Study Overview

• Status: Recruiting
• Conditions: Burn Injuries

Detailed Description

The aim of this study is to evaluate the prognostic utility of the red cell distribution width/albumin ratio (RAR), measured within 24 hours of hospital admission, in predicting 30-day mortality among patients with burn injuries.

Patients presenting with acute thermal injuries will be screened based on inclusion/exclusion criteria.

After consent, patients' characteristics (age, sex, weight), clinical parameters (total burn surface area, Abbreviated Burn Severity Index), and comorbidities will be recorded.

1. Emergency Department (ED) management (Arrival and Initial Stabilization)

   • Primary survey (ATLS principles): Immediate stabilization of Airway, Breathing, Circulation, Disability, Exposure (ABCDE).

   • Urinary catheter insertion to monitor urine output for proper resuscitation.
   • TBSA will be estimated using the Rule of Nines
   • All patients will be treated during the first 24 hours after burn injury guided by the Parkland Formula.

2. In-Hospital Resuscitation (0-72 h)

   • Hemodynamic monitoring: ECG, pulse oximetry, respiratory rate, temperature, non-invasive blood pressure, arterial line if unstable, and central venous pressure.

   • Transition to Day 2 (24-48 h post-burn): Continue Lactated Ringer's and consider colloid therapy (5% albumin or plasma) after 24 h to maintain oncotic pressure and reduce crystalloid load.

   • Fluid adjustments according to urine output, mean arterial pressure with target MAP (≥65 mmHg), lactate clearance, and base deficit.

   Laboratory and calculation:

   On admission to ED, an arterial blood gas (ABG) sample will be collected to calculate base deficit (BD) and lactate level.

   Simultaneously, venous blood will be drawn for C-reactive protein (CRP) and serum albumin, CBC, serum urea, creatinine, AST, ALT, and electrolytes (Na+, K+, Mg+) estimation.

   Red Cell Distribution Width/Albumin will be calculated as:

   ((RDW (Standard Deviation of Red Blood Cell Volume / Mean Corpuscular Volume) × 100%.) / albumin (g/L)) from admission labs.

   Serial: Lactate/Base Deficit at 6 hr, 12 hr, 24 hr as a monitor for proper resuscitation Calculation of Severity Scores

   • R-Baux score: Age (years) + %TBSA + (17 × inhalation injury [yes=1, no=0])

   • Abbreviated Burn Severity Index (ABSI): The ABSI includes five parameters: sex, age category, %TBSA, presence of full-thickness burns, and inhalation injury. Each parameter is assigned weighted points, and the total ABSI score is associated with graded survival probabilities.

   Both scores will be calculated on admission and compared with admission (RDW/albumin) ratio to assess relative and incremental predictive value for 30-day mortality.

   Supportive care:

   • Early enteral nutrition, proper multimodal analgesia (paracetamol 1gm/8hr, nalbuphine 0.1mg/kg if VAS score>4), IV proton pump inhibitor to guard against curling ulcer, prophylactic anticoagulation to guard against DVT.

   • Vasopressors (norepinephrine) only after adequate fluid resuscitation guided by UOP, lactate and BD if MAP below 65 mmHg.

     3 - Post-Resuscitation and Definitive Management Protocol (After 72 h) Hemodynamic stabilization (post-resuscitation phase) Transition from resuscitation fluids to maintenance fluids. Avoid "fluid creep" (excess positive balance leading to pulmonary edema, abdominal compartment). → cautious use of diuretics to mobilize edema.

   Maintain: MAP ≥65 mmHg, urine output ≥0.5 mL/kg/h. Ongoing ventilatory support if required; lung-protective strategy for ARDS. Weaning as early as possible.

   Infection prevention and sepsis monitoring

   • Daily wound assessment for signs of infection, weekly or targeted wound/blood cultures and antibiotics only if infection is suspected/proven (not prophylactic).

   Wound care and surgical management

   • Regular dressing, use of negative-pressure wound therapy when indicated.

   • Early excision and grafting after 72 hr. Pain and sedation control
   • Multimodal analgesia, pre-procedure analgesia for dressing/grafting and long-term psychological and pain management.

   Rehabilitation and functional recovery • Early physiotherapy, occupational therapy for daily living skills and psychosocial support for patient and family.

   Criteria for transfer to ward • Hemodynamically stable, off vasopressors.

   • Stable oxygenation without advanced ventilatory support.

   • Tolerating enteral feeding.

   • Wounds coverage completed or adequately covered with new TBSA% below 20%.

   • Patients will be followed for 30 days at Ain Shams University burn unit. Measured outcomes

   Primary outcome:

   To determine the correlation between Red Cell Distribution Width/Albumin on admission and 30-day hospital mortality in burn patients.

   Secondary outcomes:

   To determine the correlation between Red Cell Distribution Width/Albumin with:

   • ICU length of stay
   • Hospital length of stay
   • Requirements of inotropes or vasopressors
   • Duration of mechanical ventilation
   • To compare Red Cell Distribution Width/albumin ratio with R-Baux score as a predictor of mortality in burn patients.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: Ahlam M abdelnaby. study principal investigator, MBBCH, MSc .; Phone Number: +201120327604; Email: g19-29502090100101@med.asu.edu.eg
• Study Contact Backup: Name: Sara H Saleh, MD; Phone Number: +201001584305

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt, 11111
      • Recruiting
      • Ain Shams University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients presenting with acute thermal injuries will be screened based on inclusion/exclusion criteria.

After consent, Patients' characteristics (age, sex, weight), clinical parameters (Total burn surface area, Abbreviated burn severity index), and comorbidities will be recorded.

Description

Inclusion Criteria:

• Age > 18 years.
• Both sexes.
• Patients with burn injuries (%TBSA >20%).
• Availability of complete laboratory data (RDW, albumin) on admission.
• Admission to ICU within 24 hours of burn injury.

Exclusion Criteria:

• Age <18 years.
• Patients with chronic hematologic disease.
• Pre-existing liver disease.
• Nephrotic syndrome.
• patients on chemotherapy.
• Patients with incomplete or missing lab records.
• Pregnant females.
• Patient or guardian refusal.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
• Patients with burn injuries (%TBSA >20%); each patient will be followed for 30 days for mortality prediction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
mortality in burn patients	To determine the correlation between Red Cell Distribution Width/Albumin on admission and 30 days hospital mortality in burn patients.	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ICU length of stay	To determine the correlation between Red Cell Distribution Width/Albumin with o ICU length of stay	30 days
Requirements of inotropes or vasopressors	To determine the correlation between Red Cell Distribution Width/Albumin with o Requirements of inotropes or vasopressors	30 days
Duration of mechanical ventilation	To determine the correlation between Red Cell Distribution Width/Albumin with o Duration of mechanical ventilation	30 days
To compare RDW/albumin ratio with Revised Baux score as a predictor of mortality in burn patient.	Revised Baux score = (percent body surface burned) + (patient's age) + 17 (if inhalational injury is present) A higher Revised Baux score generally indicates a higher risk of mortality, with scores over 140 unsurvivable .	30 days

Collaborators and Investigators

• Sponsor: Ain Shams University
• Investigators: Study Chair: Adel M Fahmy Shenouda, MD, Department of Anesthesia, Intensive care and pain management, Faculty of Medicine, Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: August 8, 2026
• First Submitted That Met QC Criteria: August 8, 2026
• First Posted (Actual): August 12, 2026

Study Record Updates

• Last Update Posted (Actual): August 18, 2026
• Last Update Submitted That Met QC Criteria: August 15, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: albumin; mortality; burn; Red Cell Distribution Width
• Additional Relevant MeSH Terms: Wounds and Injuries; Burns
• Other Study ID Numbers: FMASU MD361/2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the study results will be made available upon reasonable request from qualified researchers
• IPD Sharing Time Frame: Within 6:12 months
• IPD Sharing Access Criteria: Access will be granted to researchers who submit a methodologically sound proposal to the principal investigator. Requests should be directed to g19-29502090100101@med.asu.edu.eg
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No