Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients

Abstract

BackgroundIn upper gastrointestinal bleeding (UGIB) patients, early risk stratification allows appropriate therapy that may be helpful for reducing morbidity and mortality.Objectivesto evaluate the efficacy of red-cell distribution width (RDW) for prediction of high-risk in UGIB patients.MethodsWe conducted a clinical retrospective observational study based on data for UGIB patients from 2012 to 2013. The primary outcome was the high-risk UGIB, defined as those who required urgent intervention and/or 30-days mortality. RDW was categorized into four quartiles: Q1 (≤12.8%), Q2 (12.9–14.4%), Q3 (14.5–16.5%), and Q4 (≥16.6%), and multivariable analysis was performed after adjustment of multiple other risk factor. We also evaluated the efficacy of addition of RDW scores to the Pre-endoscopic Rockall Score (PRS) and the Glasgow Blatchford Score (GBS) scoring system.ResultsOf 360 UGIB patients, 229 (63.6%) were high risk. In multivariable analysis, Q3 and Q4 were strongly associated with high risk; odds ratio (95% Confidence Interval) was 3.144 (1.250–7.905) and 4.182 (1.483–11.790) respectively (all p < 0.05). For lower GBS score group (≤ 6), the incidence of high risk was higher in Q4 (30%) and Q3 (20%) than in Q2 (12.5%) and Q1 (11.4%). For lower PRS group (≤ 2), the incidence of high-risk was higher in Q4 (73.7%) and Q3 (57.1%) than in Q1 (35.4%). Receiver operating characteristic analysis showed higher discrimination power in PRS + RDW (Area Under Curve [AUC] = 0.749) than PRS (AUC = 0.715) alone (p = 0.036). Otherwise GBS + RDW (AUC = 0.873) did not show a significant higher discrimination power than the GBS (AUC = 0.864) alone (p = 0.098).ConclusionsFor UGIB patients, a high RDW (≥ 14.5%) was strongly associated with high risk UGIB. In practice, the combination of RDW with the PRS scoring indexes may increase the accuracy of risk stratification.

The relationship between red cell distribution width and all-cause and cause-specific mortality in a general population

“…In our study, death due to gastrointestinal cancer was significantly associated with RDW. Gastrointestinal hemorrhage is commonly seen in diseases of digestive organs, which potentially could stimulate erythropoietin (EPO) production and provoke anisocytosis 19 . However, the relationship was not completely attenuated after adjustment for anaemia, which might suggest that gastrointestinal bleeding is not the only reason for the increased RDW.…”

The Association between Prognostic Nutritional Index (PNI) and Intraoperative Transfusion in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma: A Retrospective Cohort Study

“…Deterioration of liver function and cirrhosis on its own makes surgery difficult and may increase the risk of bleeding, associated with a thrombotic state [ 47 , 48 ]. In addition, recent studies reported that elevated RDW may be associated with bleeding risk [ 49 ]. The suppression of erythrocyte maturation by inflammatory cytokines causes anisocytosis and abnormal erythropoietin function, which is associated with anemia, thrombotic state [ 50 ], and hemorrhagic tendency [ 49 , 51 ].…”

“…In addition, recent studies reported that elevated RDW may be associated with bleeding risk [ 49 ]. The suppression of erythrocyte maturation by inflammatory cytokines causes anisocytosis and abnormal erythropoietin function, which is associated with anemia, thrombotic state [ 50 ], and hemorrhagic tendency [ 49 , 51 ]. In this study, there was a significant difference in RDW values according to the PNI cut-off value; this may have a significant correlation with the findings of the study.…”

Association Between Red Blood Cell Distribution Width and Intraoperative Transfusion in Patients Undergoing Living Donor Liver Transplantation: a Retrospective Single-center Cohort Study

“…[ [14][15][16] The mechanism by which RDW increases is not yet clear, but it has been reported to be associated with anemia, in ammatory responses and oxidative stress. [43] Increased RDW is a sign of a nutritional de cit, such as a de ciency of iron, folic acid, or vitamins B-12, which may indicate macrocytic anemia and may increase blood transfusion requirements during surgery.…”

“…Several recent studies have reported that RDW is correlated with bleeding risk and transfusion for some diseases and procedures. [14][15][16] However, there are few studies on the association between preoperative RDW and intraoperative transfusion in LT. Therefore, in this study, we evaluated the association between preoperative RDW and intraoperative blood transfusion in patients who underwent living donor liver transplantation (LDLT).…”