RDW/Albumin ratio (RAR) in premature retinopathy: Evaluation of disease risk and progression

Purpose: To determine the role of the RDW-Albumin ratio (RAR), an integrative biomarker of the multidimensional associated with inflammation, oxidative stress, and nutritional status in retinopathy of prematurity (ROP), in the assessment of the risk of disease development and progression. Methods: A total of 110 preterm infants born before the 34th gestational week were included. The medical records were retrospectively analyzed. All demographic, clinical, and laboratory data were recorded. Patients were classified into three groups: those without ROP (No-ROP), those with ROP that regressed without treatment (ROP-reg), and those with ROP requiring treatment (ROP-tx). Blood parameters, including RDW, albumin, and RAR, were analyzed in both the early and late neonatal periods. Results: Gestational age and birth weight were significantly lower, NICU length of stay, respiratory distress syndrome (RDS), mechanical ventilation, sepsis, surfactant therapy, and transfusions were more frequent in ROP cases (p<0.001 for all). Early and late RAR values were highest in the most risky group and there was a significant difference between all groups (p=0.00). Logistic regression analysis identified surfactant therapy (OR: 3.820, p=0.012), blood transfusion (OR: 8.012, p<0.001), and early-period RAR (OR: 2.010, p=0.004) as major risk factors for ROP development. ROC analysis showed that early RAR had a moderate predictive value for ROP (AUC=0.70, 95% CI: 0.601-0.805). Conclusion: Early RAR appears to be a valuable biomarker for assessing the risk of ROP in preterm infants. Its significant association with the development of ROP may provide a potential clinical benefit in early risk stratification. However, further large-scale studies are needed to confirm its clinical utility.