{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:07:55Z","timestamp":1779944875763,"version":"3.53.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Readmission is common in acute pancreatitis (AP), with a rate of about 20%. Acute kidney injury (AKI), shock, and gastrointestinal (GI) hemorrhage are serious complications related to adverse outcomes in AP. This study aimed to identify the complication most strongly associated with readmission in AP for further risk factor analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were downloaded from the MIMIC-IV database. Chi-square test and the Phi coefficient were used to explore which complication was most strongly associated with readmission in AP. Then, patients were divided into with\/without GI hemorrhage groups to observe the baseline characteristics across the two groups. LASSO regression and exploratory machine-learning algorithms involving XGBoost, random forest, and K-nearest neighbor were employed for feature selection. Moreover, restricted cubic spline (RCS) and logistic regression analyses were used to evaluate the associations of the variables with GI hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 2,004 participants with AP enrolled with 445 readmission records. Among the three complications examined, GI hemorrhage showed the strongest association with readmission. Twelve parameters related to GI hemorrhage were enrolled for feature selection, with three consistently prioritized variables: age, alanine aminotransferase (ALT), and red blood cell distribution width (RDW). GI hemorrhage had a negative relationship with ALT but was positively linked to RDW (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). When combining RDW and ALT, the multivariable regression results showed that AP patients in the low-ALT + high-RDW group exhibited the highest odds ratio (OR) of GI hemorrhage (OR = 2.315).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights that GI hemorrhage showed the strongest association with readmission among the complications examined in AP. Moreover, RDW and ALT were independently associated with GI hemorrhage risk. The low-ALT + high-RDW pattern may help identify patients at higher risk, but these findings are exploratory and require external validation before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1777755","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:00:24Z","timestamp":1779944424000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of red blood cell distribution width combined with alanine aminotransferase with gastrointestinal hemorrhage in patients with acute pancreatitis: a retrospective MIMIC-IV study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yazhen","family":"Zhan","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Shaoxing Central Hospital, Shaoxing","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaling","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Shaoxing Central Hospital, Shaoxing","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuke","family":"Zhan","sequence":"additional","affiliation":[{"name":"Hangzhou Medical College","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Shaoxing Central Hospital, Shaoxing","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinnan","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Shaoxing Central Hospital, Shaoxing","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.08.063","article-title":"Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018","author":"Peery","year":"2019","journal-title":"Gastroenterology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2747","DOI":"10.3748\/wjg.v29.i18.2747","article-title":"Current trends in acute pancreatitis: diagnostic and therapeutic challenges","volume":"29","author":"Zerem","year":"2023","journal-title":"World J Gastroenterol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/MCG.0000000000001030","article-title":"Incidence, admission rates, and predictors, and economic burden of adult emergency visits for acute pancreatitis: data from the national emergency department sample, 2006 to 2012","volume":"53","author":"Garg","year":"2019","journal-title":"J Clin Gastroenterol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1097\/MPA.0000000000000783","article-title":"The changing epidemiology of acute pancreatitis hospitalizations: a decade of trends and the impact of chronic pancreatitis","volume":"46","author":"Krishna","year":"2017","journal-title":"Pancreas."},{"key":"B5","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1097\/MPA.0000000000001228","article-title":"Temporal trends in incidence and outcomes of acute pancreatitis in hospitalized patients in the United States from 2002 to 2013","volume":"48","author":"Brindise","year":"2019","journal-title":"Pancreas."},{"key":"B6","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1097\/MPA.0000000000001275","article-title":"Trends and Outcomes of hospitalizations related to acute pancreatitis: epidemiology from 2001 to 2014 in the United States","volume":"48","author":"Gapp","year":"2019","journal-title":"Pancreas."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e112282","DOI":"10.1371\/journal.pone.0112282","article-title":"Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator? A review of the evidence","volume":"9","author":"Fischer","year":"2014","journal-title":"PLoS One."},{"key":"B8","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.pan.2017.05.391","article-title":"Predictors for early readmission in acute pancreatitis (AP) in the United States (US)\u2014a nationwide population based study","volume":"17","author":"Munigala","year":"2017","journal-title":"Pancreatology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1038\/s41575-019-0158-2","article-title":"New insights into acute pancreatitis","volume":"16","author":"Lee","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1053\/j.gastro.2018.11.082","article-title":"Acute pancreatitis: a multifaceted set of organelle and cellular interactions","volume":"156","author":"Habtezion","year":"2019","journal-title":"Gastroenterology."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.pan.2013.07.063","article-title":"IAP\/APA evidence-based guidelines for the management of acute pancreatitis","volume":"13","author":"Working","year":"2013","journal-title":"Pancreatology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1007\/s40265-022-01766-4","article-title":"Acute pancreatitis: diagnosis and treatment","volume":"82","author":"Szatmary","year":"2022","journal-title":"Drugs."},{"key":"B13","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute pancreatitis: a review","volume":"325","author":"Mederos","year":"2021","journal-title":"JAMA."},{"key":"B14","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1177\/08850666231210237","article-title":"Insulin use is associated with improved outcomes in critically Ill patients with acute pancreatitis: a retrospective matched cohort study","volume":"39","author":"Dai","year":"2024","journal-title":"J Intensive Care Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2303395","DOI":"10.1080\/0886022X.2024.2303395","article-title":"Predictive model of acute kidney injury in critically ill patients with acute pancreatitis: a machine learning approach using the MIMIC-IV database","volume":"46","author":"Lin","year":"2024","journal-title":"Ren Fail."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2194436","DOI":"10.1080\/0886022X.2023.2194436","article-title":"Development and validation of a prediction model for the early occurrence of acute kidney injury in patients with acute pancreatitis","volume":"45","author":"Wu","year":"2023","journal-title":"Ren Fail."},{"key":"B17","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1186\/s12893-023-02151-y","article-title":"Construction and validation of machine learning models for sepsis prediction in patients with acute pancreatitis","volume":"23","author":"Liu","year":"2023","journal-title":"BMC Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00006676-200301000-00002","article-title":"Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment","volume":"26","author":"Flati","year":"2003","journal-title":"Pancreas."},{"key":"B19","first-page":"1058","article-title":"Association between acute pancreatitis and peptic ulcer disease","volume":"17","author":"Lee","year":"2011","journal-title":"World J Gastroenterol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1111\/1751-2980.12206","article-title":"Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis","volume":"16","author":"Zhan","year":"2015","journal-title":"J Dig Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2605","DOI":"10.3390\/cancers16142605","article-title":"Protective effect of minimally invasive approach on postoperative peak transaminase following liver resection: a single-center propensity score-based analysis","volume":"16","author":"Ardito","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0293749","DOI":"10.1371\/journal.pone.0293749","article-title":"Non-linear association between aspartate aminotransferase to alanine aminotransferase ratio and mortality in critically ill older patients: a retrospective cohort study","volume":"18","author":"Yang","year":"2023","journal-title":"PLoS One."},{"key":"B23","doi-asserted-by":"publisher","first-page":"348","DOI":"10.20524\/aog.2020.0486","article-title":"Red cell distribution width as a marker of activity in inflammatory bowel disease: a narrative review","volume":"33","author":"Katsaros","year":"2020","journal-title":"Ann Gastroenterol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.dld.2019.12.144","article-title":"Red blood cell distribution width: A promising index for evaluating the severity and long-term prognosis of hepatitis B virus-related diseases","volume":"52","author":"Wang","year":"2020","journal-title":"Dig Liver Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1245\/s10434-021-10719-2","article-title":"Clinical significance of pretreatment red blood cell distribution width as a predictive marker for postoperative morbidity after esophagectomy for esophageal cancer: a retrospective study","volume":"29","author":"Yoshida","year":"2022","journal-title":"Ann Surg Oncol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e45497","DOI":"10.1097\/MD.0000000000045497","article-title":"Association between hemoglobin-to-red blood cell distribution width ratio and mortality in critically Ill patients with aortic dissection: a retrospective cohort study from MIMIC-IV database","volume":"104","author":"Li","year":"2025","journal-title":"Medicine (Baltimore)."},{"key":"B27","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1186\/s40001-025-02566-8","article-title":"Retinal microvasculature alteration in patients with acute pancreatitis: an observational OCTA study","volume":"30","author":"Qian","year":"2025","journal-title":"Eur J Med Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e0339879","DOI":"10.1371\/journal.pone.0339879","article-title":"Prognostic value of red blood cell distribution width in traumatic brain injury: a mediation and deep learning analysis","volume":"21","author":"Ding","year":"2026","journal-title":"PLoS One."},{"key":"B29","doi-asserted-by":"publisher","first-page":"5085","DOI":"10.2147\/IJGM.S490203","article-title":"Evaluation of HRR (hemoglobin\/red blood cell distribution width ratio) and RAR (red blood cell distribution width\/albumin ratio) in myocarditis patients: associations with various clinical parameters","volume":"17","author":"Eyiol","year":"2024","journal-title":"Int J Gen Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/17520363.2025.2471743","article-title":"Clinical relevance of HRR (hemoglobin to RDW) and RAR (RDW to albumin) in pericarditis","volume":"19","author":"Eyiol","year":"2025","journal-title":"Biomark Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1777755\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:00:26Z","timestamp":1779944426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1777755\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1777755"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1777755","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]},"article-number":"1777755"}}