Early emergency department risk signals in upper gastrointestinal bleeding: The hemoglobin-to-red cell distribution width ratio
- 1Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
- 2Department of Emergency Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
Abstract
OBJECTIVES:: Upper gastrointestinal bleeding (UGIB) is a common emergency associated with substantial morbidity and mortality. Early risk assessment is important, but some established scores require laboratory or endoscopic data not immediately available. We evaluated whether the hemoglobin (Hb)-to-red cell distribution width ratio (Hb/RDW) at emergency department presentation was associated with intensive care unit admission or mortality during the index episode.
METHODS:: This retrospective single-center study included adults presenting with UGIB between 2019 and 2023. Patients with incomplete evaluation, missing Hb or RDW values, or non-UGIB bleeding sources were excluded. Hb/RDW was calculated at presentation. Group comparisons, receiver operating characteristic analyses, and multivariable logistic regression were performed for the primary composite outcome. Additional adjusted models compared Hb/RDW with Hb and RDW individually.
RESULTS:: Among 942 patients, the primary composite outcome occurred in 121 (12.8%). Hb/RDW was lower in patients with the primary outcome (0.398 [0.296–0.539] vs. 0.568 [0.411–0.780]; P < 0.001). Discrimination was moderate (area under the curve: 0.712, 95% confidence interval [CI]: 0.664–0.757); a threshold near 0.593 yielded sensitivity 0.851 and negative predictive value 0.956. Hb/RDW remained independently associated with the primary outcome (adjusted odds ratio: 0.023, 95% CI: 0.007–0.073; P < 0.001). It performed better than Hb alone and similarly to RDW, with the greatest incremental discrimination when added to the clinical base model. Lower values were also observed in variceal bleeding.
CONCLUSION:: Lower Hb/RDW at presentation was independently associated with adverse outcomes in UGIB and may serve as an adjunctive early triage marker.
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BibTeX
@article{ucar2026early,
title = {{Early emergency department risk signals in upper gastrointestinal bleeding: The hemoglobin-to-red cell distribution width ratio}},
author = {Asli Bahar Ucar and Emre Kudu and Mustafa Altun and Sinan Karacabey and Özge Ecmel Onur and Arzu Denizbaşi Altinok},
journal = {Turkish Journal of Emergency Medicine},
year = {2026},
month = oct,
doi = {10.4103/tjem.tjem_486_25},
url = {https://doi.org/10.4103/tjem.tjem_486_25},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Early emergency department risk signals in upper gastrointestinal bleeding: The hemoglobin-to-red cell distribution width ratio
AU - Asli Bahar Ucar
AU - Emre Kudu
AU - Mustafa Altun
AU - Sinan Karacabey
AU - Özge Ecmel Onur
AU - Arzu Denizbaşi Altinok
PY - 2026
DA - 2026/10/10
JO - Turkish Journal of Emergency Medicine
DO - 10.4103/tjem.tjem_486_25
UR - https://doi.org/10.4103/tjem.tjem_486_25
AB - OBJECTIVES:: Upper gastrointestinal bleeding (UGIB) is a common emergency associated with substantial morbidity and mortality. Early risk assessment is important, but some established scores require laboratory or endoscopic data not immediately available. We evaluated whether the hemoglobin (Hb)-to-red cell distribution width ratio (Hb/RDW) at emergency department presentation was associated with intensive care unit admission or mortality during the index episode. METHODS:: This retrospective single-center study included adults presenting with UGIB between 2019 and 2023. Patients with incomplete evaluation, missing Hb or RDW values, or non-UGIB bleeding sources were excluded. Hb/RDW was calculated at presentation. Group comparisons, receiver operating characteristic analyses, and multivariable logistic regression were performed for the primary composite outcome. Additional adjusted models compared Hb/RDW with Hb and RDW individually. RESULTS:: Among 942 patients, the primary composite outcome occurred in 121 (12.8%). Hb/RDW was lower in patients with the primary outcome (0.398 [0.296–0.539] vs. 0.568 [0.411–0.780]; P < 0.001). Discrimination was moderate (area under the curve: 0.712, 95% confidence interval [CI]: 0.664–0.757); a threshold near 0.593 yielded sensitivity 0.851 and negative predictive value 0.956. Hb/RDW remained independently associated with the primary outcome (adjusted odds ratio: 0.023, 95% CI: 0.007–0.073; P < 0.001). It performed better than Hb alone and similarly to RDW, with the greatest incremental discrimination when added to the clinical base model. Lower values were also observed in variceal bleeding. CONCLUSION:: Lower Hb/RDW at presentation was independently associated with adverse outcomes in UGIB and may serve as an adjunctive early triage marker.
SN - 2452-2473
ER -