Acute upper gastrointestinal bleeding is a common presentation in emergency departments around the world. The incidence of UGIB is approximately 100 cases per 100000 population per year. Mortality rates are approximately 6-10% overall. Due to the high morbidity and mortality associated with UGIB, the emergency physician is challenged to promptly diagnose, accurately assess risk, and aggressively resuscitate patients with gastrointestinal bleeding within the confines of the emergency department.

In UGIB patients, early risk stratification allows appropriate treatment and early endoscopy that may help in reducing morbidity and mortality. Many clinical factors, including patient’s age, gender, comorbid illnesses, medications, mental status and vital signs at the time of presentations, together with laboratory parameters such as haemoglobin, blood urea nitrogen, albumin and INR levels, are known to be associated with a high risk of morbidity and mortality.

Many risk stratification scores have been developed over past couple of decades to predict the outcome and perform risk stratification in patients presenting with symptoms of UGIB. These include BLEED criteria, Rockall score, Glasgow Blatchford Score (GBS) and recently, AIMS65 score.

Among these, AIMS65 score, was found to be a simple, easy to calculate risk assessment score to predict in-hospital mortality, length of hospital stay, and health care costs in patients with acute UGIB. The AIMS65 consists of the following components: albumin level <3.0 g/dL (A), INR >1.5 (I), altered mental status (M), systolic blood pressure ≤90 mm Hg (S), and age >65 years (65). A study from Saltzman et al showed the AIMS65 score to be superior to the GBS in predicting inpatient mortality from UGIB.

Red-cell distribution width (RDW), a routine component of hemogram, represents the variability in size of circulating erythrocytes. This measure has been usually used to differentiate the etiology of anaemia. Some recent studies have reported that RDW has relationship with recurrent or massive bleeding in critical conditions, like intracranial hematoma, post-percutaneous coronary intervention and also in trauma. There have not been much studies comparing the relationship between RDW and upper GI bleed. After extensive literature search, we couldn’t identify any previous study evaluating the predictive ability of addition of RDW values to AIMS65 score and its use in risk stratification.

The rationale of this studyin UGIB patients is to assess whether the prediction of mortality and morbidity using AIMS65 score improves when used in combination with RDW.