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Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis
Yong-Cai Lv1, Yan-Hua Yao2, Juan Zhang2
1Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China.
Insights
Red cell distribution width (RDW) can predict persistent organ failure (POF) in hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Adding RDW to the BISAP score improves POF prediction sensitivity in these patients.
Area of Science:
- Gastroenterology
- Internal Medicine
- Biochemistry
Background:
- Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) patients have a higher risk of persistent organ failure (POF) compared to other causes.
- Early identification of patients at risk for POF is crucial for improving outcomes in HTG-AP.
- Current clinical scoring systems, including the Bedside Index for Severity in Acute Pancreatitis (BISAP), have limitations in predicting HTG-AP severity due to suboptimal sensitivity.
Purpose of the Study:
- To evaluate the early predictive value of red cell distribution width (RDW) for the development of POF in patients with HTG-AP.
- To determine if RDW can enhance the predictive accuracy of existing severity scores for POF in HTG-AP.
Main Methods:
- A retrospective analysis of 102 patients diagnosed with HTG-AP.
- Collection of demographic and clinical data, including RDW, upon admission.
- Comparison of RDW levels between patients with and without POF, and assessment of its predictive performance using receiver operating characteristic (ROC) curves.
Main Results:
- 33% of HTG-AP patients developed POF.
- RDW was significantly higher in patients with POF (14.4%) compared to those without (12.5%) on admission (P < 0.001).
- RDW demonstrated good discriminative power for POF (AUC=0.85, sensitivity=82.4%, specificity=77.9%) with a cutoff of 13.1%.
- A modified BISAP score incorporating RDW showed improved prediction (AUC=0.89, sensitivity=91.2%, specificity=67.6%).
Conclusions:
- RDW is a valuable and promising early predictor of POF in HTG-AP.
- Incorporating RDW into the BISAP score significantly enhances its sensitivity for predicting POF in HTG-AP patients.
- RDW offers a simple yet effective tool to improve risk stratification and potentially guide early management strategies for HTG-AP.
Background:
Compared with patients with other causes of acute pancreatitis, those with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are more likely to develop persistent organ failure (POF). Therefore, recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP), a simple parameter that is obtained 24 h after admission, is an ideal index to predict HTG-AP severity; however, the suboptimal sensitivity limits its clinical application. Hence, current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.
Aim:
To elucidate the early predictive value of red cell distribution width (RDW) for POF in HTG-AP.
Methods:
In total, 102 patients with HTG-AP were retrospectively enrolled. Demographic and clinical data, including RDW, were collected from all patients on admission.
Results:
Based on the Revised Atlanta Classification, 37 (33%) of 102 patients with HTG-AP were diagnosed with POF. On admission, RDW was significantly higher in patients with HTG-AP and POF than in those without POF (14.4% vs 12.5%, P < 0.001). The receiver operating characteristic curve demonstrated a good discriminative power of RDW for POF with a cutoff of 13.1%, where the area under the curve (AUC), sensitivity, and specificity were 0.85, 82.4%, and 77.9%, respectively. When the RDW was ≥ 13.1% and one point was added to the original BISAP to obtain a new BISAP score, we achieved a higher AUC, sensitivity, and specificity of 0.89, 91.2%, and 67.6%, respectively.
Conclusion:
RDW is a promising predictor of POF in patients with HTG-AP, and the addition of RDW can promote the sensitivity of BISAP.
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