Erythrocyte distribution width as a predictor of upper gastrointestinal bleeding induced by celecoxib

upper gastrointestinal bleeding (UGIB) can be a serious complication of celecoxib use. At this stage, very little research has been conducted to identify potential predictors that could identify patients at an early stage. Red cell distribution width (RDW) can be considered as an existing parameter in a complete blood count that has been identified as a new potential predictor.

It is aimed to evaluate the ability of RDW to predict celecoxib-associated UGIB and to study its relationship to other hematological parameters.

Four hundred patients studied were administered celecoxib retrospectively between January 2018 and August 2024. The patients were classified into non-UGIB (n=379) and UGIB (n=21) patients. UGIB patients were further subdivided depending on the amount of bleed: <250 mL, 250-400 mL, and >400 mL. We analyzed the difference in RDW, hemoglobin (Hb), Red Blood Cell Count (RBC), and Hematocrit (HCT) between the groups. The correlation between RDW and other hematology variables was assessed. The predictive value of RDW as a UGIB risk tool was assessed using the ROC Curve.

RDW values were significantly higher among patients with UGIB, while Hb, RBC, and HCT values were significantly lower compared to patients without UGIB (P < 0.05 for each). RDW values demonstrated substantial negative correlations with Hb (r = -0.543), RBC (r = -0.525), and HCT (r = -0.509). Using the ROC curve, the RDW value was found to be the most sensitive predictor of UGIB, where the sensitivity value of the threshold of 16.32% was 83.92%, and the specificity value was 60.35%, while the AUC was 0.773 (95% CI = 0.709-0.959).

RDW is a unique, cost-effective biomarker that may prospectively identify patients at higher risk for the potential complications of upper gastrointestinal bleeding secondary to the use of celecoxib. However, this must await additional prospective trials.