Evaluation of Red Cell Distribution Width and Its Ratio to Total Serum Calcium as Predictors of Severity in Acute Pancreatitis

Abstract

Background: Acute pancreatitis (AP) is a potentially fatal condition that varies in its severity at presentation. It's crucial to recognize patients with a higher likelihood of severe outcomes to enhance their prognosis by promptly providing medical or endoscopic treatment and admitting them to a specialized intensive care unit (ICU). Despite the various scoring systems and methods, there is no reliable instrument to assess the severity of AP at its presentation. Red cell distribution width (RDW) and serum calcium levels are inexpensive markers readily available upon admission that can be used to anticipate the severity of AP.

Materials and methods: An observational cross-sectional study was carried out on 85 patients admitted to a referral hospital. The AP patients were categorized into two groups: those with mild AP (MAP) and those with moderately severe/severe AP (MSAP/SAP). RDW was assessed in all patients upon admission and at the 24-hour mark.

Results: Among the 85 AP patients, 55 were diagnosed with MAP, while 17 had MSAP and 13 had SAP. The mean serum calcium levels were notably lower in patients with MSAP/SAP compared to MAP. Additionally, the modified Marshall (MM) score, bedside index for severity in acute pancreatitis (BISAP) index, RDW at 0 hours and 24 hours, and RDW/total serum calcium (RDW/TSC) ratio were significantly higher in patients with MSAP/SAP than in MAP. The BISAP index, followed by MM, emerged as the most reliable predictors of severity, with RDW/TSC also showing strong predictive value. RDW/TSC demonstrated superior predictive ability for AP severity when compared to RDW measured at admission and at 24 hours. However, no individual parameter was identified as an independent significant predictor of AP.

Conclusion: Red cell distribution width and RDW/TSC ratio are comparable to BISAP index as predictors of severity in AP. They offer a cost-effective and readily accessible means to forecast AP severity upon admission, facilitating prompt intervention at the outset.