J Korean Soc Emerg Med.  2015 Dec;26(6):517-525. 10.0000/jksem.2015.26.6.517.

Efficacy of Red Cell Distribution Width as a Predictor of High Risk and Early Mortality in Upper Gastro-intestinal Bleeding: A Pilot Clinical Study

• Kim SY
• Kim JY
• Lee JH
• Lee KR
• Hong DY
• Baek KJ
• Park SO

• KMID: 2191659
• DOI: http://doi.org/10.0000/jksem.2015.26.6.517

Abstract

PURPOSE
The aim of the study is to evaluate the efficacy of initial red cell distribution width (RDW) levels in the emergency department (ED) in predicting early 28-day mortality and high risk patients for early intervention in patients with upper gastrointestinal hemorrhage (UGIB).
METHODS
This is a retrospective clinical study including UGIB patients in the ED. All data were collected through electronic medical records. The two major endpoints were early 28-day mortality and high risk patients. We assessed the relationship between initial RDW level and high risk patients and 28-day mortality.
RESULTS
A total of 198 patients were analyzed. There were 160 high risk patients (81.8%) and 12 non-survival patients (6.1%). The mean RDW value in high risk patients was higher than in non-risk patients (15.4+/-2.8 vs. 13.6+/-1.8%; p<0.0001). Area under curve (AUC) in Receiver-operatory characteristic (ROC) curve for RDW in high risk patients was 0.735 (95% Confidence Interval: 0.649-0.821; p<0.001) with an optimal cutoff value of 13.45% with sensitivity of 69.4% and specificity of 73.7%. The mean value of RDW in non-survivals was higher than in survivals (18.0+/- 3.3 vs. 14.9+/-2.6 %; p<0.0001). AUC for RDW in predicting 28-day mortality was 0.793 (95% CI: 0.684-0.902; p<0.001) with an optimal cutoff value of 15.95% with sensitivity of 83.3% and specificity of 71.5%.
CONCLUSION
RDW level in initial state might be helpful in predicting high risk patients for early intervention and 28-day mortality in UGIB in the ED.

Keyword

Erythrocyte indices; Gastrointestinal hemorrhage

MeSH Terms

Area Under Curve
Early Intervention (Education)
Electronic Health Records
Emergency Service, Hospital
Erythrocyte Indices*
Gastrointestinal Hemorrhage
Hemorrhage*
Humans
Mortality*
Retrospective Studies
Sensitivity and Specificity