Red Cell Distribution Width-to-Platelet Count Ratio as an Early Marker of Severity in Acute Pancreatitis: A Diagnostic Accuracy Study at a Tertiary Care Center.

INTRODUCTION

Early identification of clinically significant acute pancreatitis is essential for timely escalation of care, yet established scoring systems are multiparametric, and several require 48-hour data. The red cell distribution width (RDW)-to-platelet count ratio is a composite index derived from the routine complete blood count that may reflect the systemic inflammatory burden of the disease. This study assessed its accuracy for identifying moderately severe or severe disease at admission.

METHODS

Consecutive adults admitted with acute pancreatitis were enrolled on accrual at a tertiary care center. The ratio was calculated from the admission RDW and platelet count. Disease severity was classified using the Revised Atlanta Classification; the target condition for the accuracy analysis was moderately severe or severe disease versus mild disease. Associations with the Ranson score, intensive care admission, organ failure, and length of hospital stay were examined, and discrimination was assessed using the area under the receiver operating characteristic curve.

RESULTS

Among 142 patients (mean age: 43 years; 86 (60.6%) men), 47 (33.1%) patients had moderately severe or severe disease. The ratio rose progressively across severity categories and was higher in patients requiring intensive care and those with organ failure (all p < 0.001). At a cut-off of 0.0601, it identified moderately severe or severe disease with sensitivity of 45/47 (95.7%), specificity of 74/95 (77.9%), and negative predictive value of 74/76 (97.4%) (area under the curve: 0.931).

CONCLUSIONS

The RDW-to-platelet ratio is a simple, inexpensive admission marker that showed high sensitivity and negative predictive value for clinically significant severity and may support early risk stratification, pending external validation alongside established assessment.