Background: The hemoglobin-to-red blood cell distribution width ratio (HRR) is a new inflammatory marker in evaluating tumor prognosis. However, its application in cardiovascular diseases (CVDs) is relatively limited. This research was designed to illuminate the relationship between HRR and mortality in patients with aortic dissection (AD).

Methods: The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was applied in this retrospective cohort study. The primary outcome was the 30-day mortality rate. The Cox proportional hazards model was utilized to explore the relationship between HRR and mortality in AD patients. Through restricted cubic splines (RCS), the relationship between mortality and HRR levels was analyzed. The ROC curves were graphed to evaluate the prognostic value of HRR.

Results: This retrospective cohort study included 292 patients. A significant negative linkage between HRR quartiles and 30-day mortality was identified (P < .05). Kaplan-Meier analysis demonstrated that participants in the low-HRR group exhibited worse survival rates than those in the high-HRR group (Q1 vs. Q2, log-rank P = .005; Q1 vs. Q3, log-rank P < .001; Q1 vs. Q4, log-rank P = .014). No great difference was observed between other groups. In RCS analysis, a non-linear linkage between HRR and 30-day mortality rate was observed (P < .05). Through analyzing ROC curves, HRR was found to perform well in predicting AD mortality, with AUC values of 0.628, 0.662, and 0.669 at 7, 14, and 30 days, respectively.

Conclusion: Low levels of HRR may elevate the risk of death in AD patients. The research pinpointed the potential of HRR as a prognostic biomarker for AD patients, which can provide reliable auxiliary indicators for clinical routine and interventional treatment.