The Significance of the Red Cell Distribution Width to Serum Calcium Ratio in Predicting the Severity of Acute Pancreatitis Patients

Year 2022, , 34 - 40, 31.08.2022

Murat Duyan , Ali Sarıdaş

https://doi.org/10.55994/ejcc.1131176

Abstract

Background: Although serum calcium (Ca) and red cell distribution width (RDW) can be used to predict the severity of acute pancreatitis (AP), their sensitivity and specificity are limited. The goal of this study is to see how well the serum calcium ratio of RDW, which may be measured at presenta-tion, predicts the severity of AP in patients with AP.
Materials and methods: AP patients admitted to a tertiary hospital's emergency department between 14 February 2021 and 14 February 2022 were screened retrospectively. According to the 2012 Atlanta classification guidelines, AP severity was classified as mild acute pancreatitis (MAP), moderate acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). During admittance to the emergency department, vital signs, laboratory exams, and imaging findings were gathered from the database.
Results: This study comprised 384 AP patients, including 166 males (56.8%), 239 patients with MAP, and 145 patients with MSAP or SAP. The mean RDW/Ca changes considerably according to pancreatitis severity (p<0.05). Pancreatitis severity rises considerably when RDW/Ca value increases (odds ratio: 2.27; lower( 95 % CI):1.07; upper(95 % CI):4.83; p<0.05).
Conclusion: RDW/Ca can be a valuable indicator to predict the severity of patients with AP.

Keywords

Acute pancreatitis, Red cell distribution width, Serum calcium, Disease severity

Supporting Institution

The authors declare no conflict of interest or any financial support.

Thanks

We thank biostatistics expert Elif Ertaş for her support for the statistical analysis of the article.

References

• 1. Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review. Gastroenterology. 2018;154(4):1103-1139.
• 2. Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(8):479-496.
• 3. Sarr MG. 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn. 2013;123(3):118-124.
• 4. Wang X, Cui Z, Zhang J, Li H, Zhang D, Miao B, Cui Y, et al. Early predictive factors of in hospital mortality in patients with severe acute pancreatitis. Pancreas. 2010 Jan;39(1):114-5.
• 5. Almeida N, Fernandes A, Casela A. Predictors of Severity and In-Hospital Mortality for Acute Pancreatitis: Is There Any Role for C-Reactive Protein Determination in the First 24 Hours? GE Port J Gastroenterol. 2015 Jul 3;22(5):187-189.
• 6. Cho JH, Kim TN, Chung HH, Kim KH. Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol. 2015 Feb 28;21(8):2387-94.
• 7. Miyamoto K, Inai K, Takeuchi D, Shinohara T, Nakanishi T. Relationships among red cell distribution width, anemia, and interleukin-6 in adult congenital heart disease. Circ J. 2015;79(5):1100-6.
• 8. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med. 2009 Mar 23;169(6):588-94.
• 9. Parizadeh SM, Jafarzadeh-Esfehani R, Bahreyni A, Ghandehari M, Shafiee M, Rahmani F, et al. The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective. Biofactors. 2019 Jul;45(4):507-516.
• 10. Wang B, Gong Y, Ying B, Cheng B. Relation between Red Cell Distribution Width and Mortality in Critically Ill Patients with Acute Respiratory Distress Syndrome. Biomed Res Int. 2019 Mar 21;2019:1942078.
• 11. Hu ZD, Lippi G, Montagnana M. Diagnostic and prognostic value of red blood cell distribution width in sepsis: A narrative review. Clin Biochem. 2020 Mar;77:1-6.
• 12. Goyal H, Awad H, Hu ZD. Prognostic value of admission red blood cell distribution width in acute pancreatitis: a systematic review. Ann Transl Med. 2017 Sep;5(17):342.
• 13. Feng S, Wei Q, Hu Q, Huang X, Zhou X, Luo G, et al. Research Progress on the Relationship Between Acute Pancreatitis and Calcium Overload in Acinar Cells. Dig Dis Sci. 2019 Jan;64(1):25-38.
• 14. Ye JF, Zhao YX, Ju J, Wang W. Building and verifying a severity prediction model of acute pancreatitis (AP) based on BISAP, MEWS and routine test indexes. Clin Res Hepatol Gastroenterol. 2017 Oct;41(5):585-591.
• 15. Wang QM, Luo MW, Xiao B. [Value of red blood cell distribution width in assessing the severity of acute pancreatitis]. Nan Fang Yi Ke Da Xue Xue Bao. 2017 Jul 20;37(7):993-996. Chinese.
• 16. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore). 2019 Apr;98(16):e15275.
• 17. Norman, G. (2010). Likertscales, levels of measurementandthe “laws” of statistics. Advances in HealthSciencesEducation, 15 (5), 625-632.
• 18. Liu G, Tao J, Zhu Z, Wang W. The early prognostic value of inflammatory markers in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2019 Jun;43(3):330-337.
• 19. Garg PK, Singh VP. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology. 2019 May;156(7):2008-2023.
• 20. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013 Jun;144(6):1252-61.
• 21. Wang X, Cui Z, Zhang J, Li H, Zhang D, Miao B, et al. Early predictive factors of in hospital mortality in patients with severe acute pancreatitis. Pancreas. 2010 Jan;39(1):114-5.
• 22. Gülen B, Sonmez E, Yaylaci S, Serinken M, Eken C, Dur A, et al. Effect of harmless acute pancreatitis score, red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department. World J Emerg Med. 2015;6(1):29-33.
• 23. Park JY, Jeon TJ, Ha TH, Hwang JT, Sinn DH, Oh TH, et al. Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure. Hepatobiliary Pancreat Dis Int. 2013 Dec;12(6):645-50.
• 24. He F, Zhu HM, Li BY, Li XC, Yang S, Wang Z, et al. Factors predicting the severity of acute pancreatitis in elderly patients. Aging Clin Exp Res. 2021 Jan;33(1):183-192.
• 25. Cardoso FS, Ricardo LB, Oliveira AM, Canena JM, Horta DV, Papoila AL, et al. C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol. 2013 Jul;25(7):784-9
• 26. Gutiérrez-Jiménez AA, Castro-Jiménez E, Lagunes-Córdoba R. Calcio sérico total y calcio corregido como predictores de severidad en pancreatitis aguda [Total serum calcium and corrected calcium as severity predictors in acute pancreatitis]. Rev Gastroenterol Mex. 2014 Jan-Mar;79(1):13-21. Spanish
• 27. Kılıç MÖ, Çelik C, Yüksel C, Yıldız BD, Tez M. Correlation between Ranson score and red cell distribution width in acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2017 Mar;23(2):112-116.
• 28. Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017 Sep;32(9):1649-1656.
• 29. Hu ZD, Chen Y, Zhang L, Sun Y, Huang YL, Wang QQ, et al. Red blood cell distribution width is a potential index to assess the disease activity of systemic lupus erythematosus. Clin Chim Acta. 2013 Oct 21;425:202-5.
• 30. Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013 Apr;31(4):687-9.
• 31. Wang D, Yang J, Zhang J, Zhang S, Wang B, Wang R, et al. Red cell distribution width predicts deaths in patients with acute pancreatitis. J Res Med Sci. 2015 May;20(5):424-8. doi: 10.4103/1735-1995.163951.
• 32. Sharma D, Jakkampudi A, Reddy R, Reddy PB, Patil A, Murthy HVV, et al. Association of Systemic Inflammatory and Anti-inflammatory Responses with Adverse Outcomes in Acute Pancreatitis: Preliminary Results of an Ongoing Study. Dig Dis Sci. 2017 Dec;62(12):3468-3478.
• 33. Gravito-Soares M, Gravito-Soares E, Gomes D, Almeida N, Tomé L. Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis. BMC Gastroenterol. 2018 Jul 5;18(1):108.
• 34. Komolafe O, Pereira SP, Davidson BR, Gurusamy KS. Serum C-reactive protein, procalcitonin, and lactate dehydrogenase for the diagnosis of pancreatic necrosis. Cochrane Database Syst Rev. 2017 Apr 21;4(4):CD012645.
• 35. Rajput R, Mittal A, Singh J, Dalal S, Vohra S. Recurrent diabetic ketoacidosis: a rare presenting manifestation of primary hyperparathyroidism. Clin Cases Miner Bone Metab. 2016 Sep-Dec;13(3):262-264.
• 36. Han T, Cheng T, Liao Y, He Y, Liu B, Lai Q, et al. The ratio of red blood cell distribution width to serum calcium predicts severity of patients with acute pancreatitis. Am J Emerg Med. 2022 Mar;53:190-195.
• 37. Gravito-Soares M, Gravito-Soares E, Gomes D, Almeida N, Tomé L. Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis. BMC Gastroenterol. 2018 Jul 5;18(1):108.