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Red Blood Cell Distribution Width as a Risk Factor for 30/90-Day Mortality in Patients with Gastrointestinal Bleeding: Analysis of the MIMIC-IV Database

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An Invited Commentary to this article was published on 09 April 2024

Abstract

Purpose

The purpose of this research was to assess the relationship between red blood cell distribution width (RDW) and mortality in patients with gastrointestinal (GIB) bleeding in the intensive care unit (ICU).

Methods

The information of the participants was obtained from the Medical Information Mart for Intensive Care IV database. The main outcome of this research was 30/90-day mortality, with ICU mortality and in-hospital mortality as secondary outcomes.

Results

This research included 2924 patients with gastrointestinal bleeding in total. Patients with higher RDW had considerably higher 30/90-day and in-hospital mortality rates, as well as longer hospital stays and ICU stays. According to the Kaplan–Meier analysis, the 30/90-day mortality rate was remarkably higher among participants in the higher RDW group (P < 0.0001). In the adjusted multivariate Cox regression analysis, for 30-day mortality, the HR (95% CI) was 1.75 (1.37, 2.24) in comparison to Q1 in the reference group (P < 0.001). Analyses of 90-day mortality and in-hospital mortality both showed the same results. In the subgroup analysis, gender, myocardial infarction, chronic pulmonary disease, cerebrovascular disease and renal disease had no significant effect on the correlation between RDW values and mortality (all P > 0.05). The area under the ROC curve for RDW was 0.599 (95% CI 0.581–0.617) and 0.606 (95% CI 0.588–0.624) in 30/90-day ICU mortality.

Conclusion

The current research showed that RDW could be utilized as an independent indicator of short-term mortality in critically ill GIB patients at 30 and 90 days of hospital admission.

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Data availability

The data sources are accessible to the general public via https://mimic.physionet.org/.

References

  1. Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008 Sep;6:1004–10; quiz 955-.

  2. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021May 1;116:899–917.

    Article  CAS  PubMed  Google Scholar 

  3. Kwak MS, Cha JM, Han YJ et al. The Clinical Outcomes of Lower Gastrointestinal Bleeding Are Not Better than Those of Upper Gastrointestinal Bleeding. J Korean Med Sci. 2016Oct;31:1611–1616.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lenti MV, Pasina L, Cococcia S, et al. REPOSI Investigators. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med. 2019 Mar;61:54–61.

  5. Shteinshnaider M, Barchel D, Almoznino-Sarafian D et al. Prognostic significance of changes in red cell distribution width in an internal medicine ward. Eur J Intern Med. 2015Oct;26:616–622.

    Article  PubMed  Google Scholar 

  6. Nabais S, Losa N, Gaspar A et al. Association between red blood cell distribution width and outcomes at six months in patients with acute coronary syndromes. Rev Port Cardiol. 2009Sep;28:905–924.

    PubMed  Google Scholar 

  7. Azab B, Torbey E, Hatoum H et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology. 2011;119:72–80.

    Article  PubMed  Google Scholar 

  8. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52:86–105.

    Article  PubMed  Google Scholar 

  9. Fatemi O, Torguson R, Chen F, et al. Waksman R. Red cell distribution width as a bleeding predictor after percutaneous coronary intervention. Am Heart J. 2013 Jul;166:104–9.

  10. Liao Y, Zhang R, Shi S et al. Red blood cell distribution width predicts gastrointestinal bleeding after coronary artery bypass grafting. BMC Cardiovasc Disord. 2022Oct 6;22:436.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Isik B, Yilmaz MS, Yel C et al. Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage. J Pak Med Assoc. 2016Feb;66:151–154.

    PubMed  Google Scholar 

  12. Lee KR, Park SO, Kim SY et al. Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients. PLoS One. 2017Nov 2;12:e0187158.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Johnson AEW, Bulgarelli L, Shen L et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023Jan 3;10:1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Song W, Mobli K, Jupiter DC, Radhakrishnan RS. CVP and echo Measurements are Associated with Improved Outcomes in Patients with Gastrointestinal (GI) Hemorrhage: A Retrospective Analysis of the MIMIC- IV Database. J Intensive Care Med. 2022Jul;37:925–935.

    Article  PubMed  Google Scholar 

  15. Hussain H, Lapin S, Cappell MS. Clinical scoring systems for determining the prognosis of gastrointestinal bleeding. Gastroenterol Clin North Am. 2000Jun;29:445–464.

    Article  CAS  PubMed  Google Scholar 

  16. Liu P, Luo S, Duan XJ et al. RDW-to-ALB Ratio Is an Independent Predictor for 30-Day All-Cause Mortality in Patients with Acute Ischemic Stroke: A Retrospective Analysis from the MIMIC-IV Database. Behav Neurol. 2022Dec;15:3979213.

    Google Scholar 

  17. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010Feb 1;105:312–317.

    Article  PubMed  Google Scholar 

  18. van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail. 2010Feb;12:129–136.

    Article  PubMed  Google Scholar 

  19. Braun E, Domany E, Kenig Y, Mazor Y, Makhoul BF, Azzam ZS. Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. Crit Care. 2011Aug 11;15:R194.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Marek TA. Gastrointestinal bleeding. Endoscopy. 2011Nov;43:971–977. https://doi.org/10.1055/s-0031-1291429. (Epub 2011 Nov 4).

    Article  CAS  PubMed  Google Scholar 

  21. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996Mar;38:316–321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000Oct 14;356:1318–1321.

    Article  CAS  PubMed  Google Scholar 

  23. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74:1215–1224.

    Article  PubMed  Google Scholar 

  24. Horibe M, Iwasaki E, Bazerbachi F et al. Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding. Gastrointest Endosc. 2020;92:578-588.e4.

    Article  PubMed  Google Scholar 

  25. Sung JJ, Tsoi KK, Ma TK, Yung MY, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol. 2010Jan;105:84–89.

    Article  PubMed  Google Scholar 

  26. Felker GM, Allen LA, Pocock SJ, et al. CHARM Investigators. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007 Jul 3;50:40–7.

  27. Lee JH, Chung HJ, Kim K et al. Red cell distribution width as a prognostic marker in patients with community-acquired pneumonia. Am J Emerg Med. 2013Jan;31:72–79.

    Article  PubMed  Google Scholar 

  28. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Invest. 2008;68:745–748.

    Article  CAS  PubMed  Google Scholar 

  29. Spell DW, Jones DV Jr, Harper WF, David Bessman J. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev. 2004;28:37–42.

    Article  PubMed  Google Scholar 

  30. Lou Y, Wang M, Mao W. Clinical usefulness of measuring red blood cell distribution width in patients with hepatitis B. PLoS One. 2012;7:e37644.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kayadibi H, Sertoglu E, Uyanik M, Tapan S. Is increased red cell distribution width an indicating marker of nonalcoholic steatohepatitis and fibrotic stage? World J Gastroenterol. 2014Sep 21;20:12711–12712.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kario K, Matsuo T, Nakao K, Yamaguchi N. The correlation between red cell distribution width and serum erythropoietin titres. Clin Lab Haematol. 1991;13:222–223.

    Article  CAS  PubMed  Google Scholar 

  33. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008Jul 24;454:436–444.

    Article  CAS  PubMed  Google Scholar 

  34. Bessman JD. Red blood cell fragmentation. Improved detection and identification of causes. Am J Clin Pathol. 1988 Sep;90:268–73.

  35. Lippi G, Filippozzi L, Montagnana M et al. Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes. Clin Chem Lab Med. 2009;47:353–357.

    Article  CAS  PubMed  Google Scholar 

  36. Veeranna V, Zalawadiya SK, Panaich SS, Ramesh K, Afonso L. The association of red cell distribution width with glycated hemoglobin among healthy adults without diabetes mellitus. Cardiology. 2012;122:129–132.

    Article  CAS  PubMed  Google Scholar 

  37. Nable JV, Graham AC. Gastrointestinal Bleeding. Emerg Med Clin North Am. 2016May;34:309–325.

    Article  PubMed  Google Scholar 

  38. Rahman M, Shad F, Smith MC. Acute kidney injury: a guide to diagnosis and management. Am Fam Physician. 2012Oct 1;86:631–639.

    PubMed  Google Scholar 

  39. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005Nov;16:3365–3370.

    Article  PubMed  Google Scholar 

  40. Jiménez-Rosales R, Valverde-López F, Vadillo-Calles F, Martínez-Cara JG, López de Hierro M, Redondo-Cerezo E. Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series. Scand J Gastroenterol. 2018 Jun;53:714–720.

  41. Semba RD, Patel KV, Ferrucci L et al. Serum antioxidants and inflammation predict red cell distribution width in older women: the Women’s Health and Aging Study I. Clin Nutr. 2010Oct;29:600–604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Pierce CN, Larson DF. Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device. Perfusion. 2005Mar;20:83–90. https://doi.org/10.1191/0267659105pf793oa. (Erratum in: Perfusion. 2005 May;20(3):183).

    Article  PubMed  Google Scholar 

  43. Horta-Baas G, Romero-Figueroa MDS. Clinical utility of red blood cell distribution width in inflammatory and non-inflammatory joint diseases. Int J Rheum Dis. 2019Jan;22:47–54.

    Article  CAS  PubMed  Google Scholar 

  44. Tanyong DI, Panichob P, Kheansaard W, Fucharoen S. Effect of Tumor Necrosis Factor-Alpha on Erythropoietin and Erythropoietin Receptor-Induced Erythroid Progenitor Cell Proliferation in β-Thalassemia/Hemoglobin E Patients. Turk J Haematol. 2015Dec;32:304–310.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Afsar B, Saglam M, Yuceturk C, Agca E. The relationship between red cell distribution width with erythropoietin resistance in iron replete hemodialysis patients. Eur J Intern Med. 2013Apr;24:e25–e29.

    Article  CAS  PubMed  Google Scholar 

  46. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med. 2011Dec 17;50:635–641.

    PubMed  Google Scholar 

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Author information

Author notes

  1. Yu Chen and Yang Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People’s Republic of China

    Yu Chen, Li Ming & Tan Shiyun

  2. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, Merseyside, L7 8TX, UK

    Yang Chen

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Correspondence to Tan Shiyun.

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The authors declare that they have no competing interests.

Ethical approval

The MIMIC-IV database we used for this investigation was authorized by the Massachusetts Institute of Technology Institutional Review Boards (IRB) and does not include private medical information. Thus, for this research, it was not necessary to get informed consent or follow the ethical approval process.

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An invited commentary on this article is available at https://doi.org/10.1007/s10620-024-08296-x

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Chen, Y., Chen, Y., Ming, L. et al. Red Blood Cell Distribution Width as a Risk Factor for 30/90-Day Mortality in Patients with Gastrointestinal Bleeding: Analysis of the MIMIC-IV Database. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08295-y

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