Early emergency department risk signals in upper gastrointestinal bleeding: The hemoglobin‑to‑red cell distribution width ratio

Asli Bahar Ucar; Emre Kudu; Mustafa Altun; Sinan Karacabey; Özge Ecmel Onur; Arzu Denizbaşi Altinok

doi:10.4103/tjem.tjem_486_25

Asli Bahar Ucar¹, Emre Kudu², Mustafa Altun¹, Sinan Karacabey², Özge Ecmel Onur², Arzu Denizbaşi Altinok²

¹Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
²Department of Emergency Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye

Keywords: Endoscopy, gastrointestinal bleeding, gastrointestinal hemorrhage, hemoglobin‑to‑red cell distribution width, hemoglobin, intensive care, red cell distribution width

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.

How to cite this article: Ucar AB, Kudu E, Altun M, Karacabey S, Onur OE, Altinok AD. Early emergency department risk signals in upper gastrointestinal bleeding: The hemoglobin‑to‑red cell distribution width ratio. Turk J Emerg Med 2026;26:314-20.