Turcato G, et al. - The researchers investigated whether red blood cell distribution width (RDW) could help in predicting the risk of short-term mortality in acute decompensation of cirrhotic patients admitted to the Emergency Department (ED). At ED admission, the assessment of RDW could improve risk stratification of patients with acute decompensation of cirrhosis.

Methods

• From 1 June 2013 and 31 December 2016, the researchers performed a retrospective analysis of all patients consecutively admitted to the ED of the University Hospital of Verona (Italy) for acute decompensation of liver cirrhosis.
• They measured the RDW value at ED admission and collected the clinical features and other laboratory data.
• Then, the data was correlated with severity of disease (Chronic Liver Failure Consortium Acute Decompensation score; CLIF-C AD score) and 1-month mortality.

Results

• A total of 542 patients were analyzed in the final assessment.
• Out of them, 80 (14.8%) patients died within 30 days after ED admission.
• The researchers observed a significantly higher median RDW of patients who died than the median RDW of those who survived (17.4% vs 15.5%; P < 0.001).
• Across different RDW quartiles, the percentage of patients who died significantly increased (6.8%, 9.7%, 11.5% and 32.1%, P < 0.001).
• In univariate analysis, they observed a significant correlation between RDW and clinical severity of acute decompensate cirrhosis (Child-Pugh score: r=0.198, P < 0.001; Model for End-Stage Liver Disease score: r=0.311, P=0.001; CLIF-C AD: 0.127, P=0.005).
• For predicting 1-month mortality, the combination of RDW and CLIF-C AD score exhibited better performance than the CLIF-C AD score alone (area under the curve=0.769 vs 0.720; P=0.006).
• RDW was independently correlated with a 1.2-2.3 higher risk of 1-month mortality in multivariate analysis.