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Original Research

Open Access

Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleedingpatients


1Sisli Etfal Training and Research Hospital, Emergency department, İstanbul/Turkey

2Baskent University Faculty of Medicine, Ankara

DOI: 10.22514/SV152.102019.9 Vol.15,Issue 2,September 2019 pp.59-64

Published: 20 September 2019

*Corresponding Author(s): CEMIL KAVALCI E-mail:


Background: In this study, we aimed to examine demographic and endoscopic features of patients with GI bleeding to determine the factors affecting 30-day mortality. Method: Patient’s demographic features, laboratory outcomes, comor-bidities, drug use, endoscopy outcomes, Glasgow-Blatchford scores, and mortality status were examined. The factors affect-ing 30-day mortality were investigated. Results: The mean age of the patients was 58.2±17.4 years, and 72.1% were male pa-tients. 30-day mortality rate was found to be 14.4%. The mean age of patients who died was high (p<0.05). The incidence of mortality was high in the presence of comorbidity, malignancy, and cirrho-sis (p<0.05). Systolic blood pressure was low in the patients who died (p<0.05). No significant correlation was found be-tween mortality and gender, symptoms, predisposing factors, lesion type and For-rest score, diastolic blood pressure and heart rate (p>0.05). Urea, neutrophils, red blood cell distribution width / platelet ratio, neutrophil / lymphocyte ratio and RDW levels were high, and hemoglobin level was significantly low in patients with a mortal progression (p<0.05). No signifi-cant correlation was found between mor-tality, and platelet and lymphocyte levels (p>0.05). Glasgow-Blatchford score was significantly higher in patients who died (p<0.05). Conclusion: Many factors affect 30-day mortality in GI bleeding. It should be remembered that follow-up of patients with an advanced age who have comorbid-ity and impaired hemodynamics should be kept for long, and that these patients are at a high risk for mortality.According to our results, NLR and RDW are independent factors that determine the 30-day mortality in upper GI bleeding.


emergency, mortality, NLR, RDW

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ERTUGRUL ALTINBILEK,DERYA OZTURK,CEMIL KAVALCI. Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleedingpatients. Signa Vitae. 2019. 15(2);59-64.


1. Vreeburg E, Terwee C, Snel P, Rauws E, Bartelsman J, VdMeulen J, et al. Validation of the Rockall risk scoring system in upper gas-trointestinal bleeding. Gut 1999;44(3):331-5.

2. Yalçin MS, Kara B, Öztürk NA, Ölmez S, Tasdogan BE, Tas A. Epidemiology and Endoscopic Findings of the Patients Suffering from Upper Gastrointestinal System Bleeding. Dicle Tip Derg 2016;43(1):73.

3. Szura M, Pasternak A. Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods. World J Gastrointest Endosc 2015;7(13):1088.

4. Sey MSL, Mohammed SB, Brahmania M, Singh S, Kahan BC, Jairath V. Comparative outcomes in patients with ulcer vs nonulcer related acute upper gastrointestinal bleeding in the United Kingdom: a nationwide cohort of 4478 patients. Aliment Pharmacol Ther. 2019: 49(5):537-545

5. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc 2015;81(4):882-8. e1.

6. Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci 2018;63(5):1286-93.

7. Cander B, Ertekin B, Hasan K, Mehmet G, Dündar D, Koçak S, et al. Factors Affecting The Length of Hospitalization at The Patients Admit to Emergency Department With Gastrointestinal Bleeding. Fırat Tıp Derg 2011;16(2):051-4.

8. Sung JJ, Tsoi KK, Ma TK, Yung MY, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol 2010;105(1):84-9.

9. Saeed ZA, Ramirez FC, Hepps KS, Cole RA, Graham DY. Prospective validation of the Baylor bleeding score for predicting the likeli-hood of rebleeding after endoscopic hemostasis of peptic ulcers. Gastrointest Endosc 1995;41(6):561-5.

10. Kandemir A, Süle M, Yavaşoğlu İ, Türe M, Coşkun A, Yükselen A, et al. Assessment of the Relationship Between Leukocyte Count and Neutrophil-to-Lymphocyte Ratio and Clinical Course in Non-Variceal Upper Gastrointestinal System Bleeding. SakaryaTıp Dergisi 2018;8(2):320-6.

11. Peng Z, He Z, Guo X, Tacke F, Yang S-S, Sugawara Y, et al. Neutrophil to lymphocyte ratio and albumin-bilirubin score for predicting the in-hospital mortality of hepatocellular carcinoma with acute upper gastrointestinal bleeding. AME Med J 2017;2(11).

12. Isik B, Yilmaz MS, Yel C, Kavalci C, Solakoglu GA, Özdemir M, et al. Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage. JPMA 2016;66(2):151-4.

13. Özdemir R, Mutlu NM, Özdemir M, Akcay M, Yel C, TURAN IÖ. The importance of red cell distribution width (RDW) in patient follow up in intensive care unit (ICU). Acta Med Mediter 2016;32:349-54.

14. Christensen S, Riis A, Norgaard M, Sorensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr 2007;7:8.

15. Marmo R, Koch M, Cipolletta L, Bianco MA, Grossi E, Rotondano G, et al. Predicting mortality in patients with in-hospital nonvar-iceal upper GI bleeding: a prospective, multicenter database study. Gastrointest Endosc 2014;79(5):741-9 e1.

16. Lee YJ, Min BR, Kim ES, Park KS, Cho KB, Jang BK, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med 2016;31(1):54-64.

17. Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gas-troenterology 2011;141(1):62-70.

18. Önder A, Kapan M, Taşkesen F, Aliosmanoğlu İ, Arıkanoğlu Z, Gül M, et al. Risk factors in non-variceal and non-malignancy upper gastrointestinal system bleedings in the patients undergoing surgery. Turk J Surg 2011;27(4):216-21.

19. Gölgeli H, Ecirli Ş, Kutlu O, Başer H, Karasoy D. Evaluation of the patients that followed up for upper gastrointestinal system bleed-ing. Dicle Med J 2014; 41: 495-501.

20. Adamopoulos AB, Baibas NM, Efstathiou SP, Tsioulos DI, Mitromaras AG, Tsami AA et al. Differentiation between patients with acute upper gastrointestinal bleeding who need early urgent upper gastrointestinal endoscopy and those who do not. A prospective study. Eur J Gastroenterol Hepatol 2003;15: 381-7.

21. Lanas A, Aabakken L, Fonseca J, Mungan ZA, Papatheodoridis GV, Piessevaux H, et al. Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe. Aliment Pharmacol Ther 2011;33(11):1225-33.

22. Thomopoulos KC, Vagenas KA, Vagianos CE, Margaritis VG, Blikas AP, Katsakoulis EC, et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. European J Gastroenterol Hepatol 2004;16(2):177-82.

23. Baradaran F, Norouzi A, Tavassoli S, Baradaran A, Roshandel G. Factors associated with outcome in patients with acute upper gas-trointestinal bleeding in a tertiary referral center in Northern Iran. Middle East J Dig Dis 2016;8(3):201.

24. Siddique SM, Mehta SJ, Lewis JD, Neuman MD, Werner RM. Rates of hospital readmission among Medicare beneficiaries with gas-trointestinal bleeding vary based on etiology and comorbidities. Clin Gastroenterol Hepatol 2019;17(1):90-7. e3.

25. Lahiff C, Shields W, Cretu I, Mahmud N, McKiernan S, Norris S, et al. Upper gastrointestinal bleeding: predictors of risk in a mixed patient group including variceal and nonvariceal haemorrhage. Eur J Gastroenterol Hepatol 2012;24(2):149-54.

26. Jung SH, Oh JH, Lee HY, Jeong JW, Go SE, You CR, et al. Is the AIMS65 score useful in predicting outcomes in peptic ulcer bleeding?World J Gastroenterol 2014;20(7):1846-51.

27. Chalasani N, Clark WS, Wilcox M. Blood urea nitrogen to creatinine concentration in gastrointestinal bleeding: a reappraisal. Am J Gastroenterol 1997;92(10):1796-9

28. Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol 2015;21(24):7500-7505

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