This retrospective study included 1,314 cardiogenic-shock patients across MIMIC-IV and a single-center external validation cohort. Higher red cell distribution width-to-albumin ratio (RAR) was associated with 28-day ICU mortality after adjustment (HR per unit 1.134, 95% CI 1.076–1.197). The association persisted in external validation (HR 1.359, 95% CI 1.177–1.568). For 28-day in-hospital mortality, the adjusted HR per unit was 1.085 (95% CI 1.031–1.141). A model incorporating RAR and five other clinical features showed moderate discrimination, with AUCs of 0.71, 0.70, and 0.75 in training, test, and external validation sets.
RAR was associated with short-term mortality in cardiogenic shock, but prospective validation is needed before its added value for clinical risk stratification is established.
Study limitation: Retrospective observational data remain vulnerable to residual confounding; external validation came from only one center.
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