D-Dimer as a Single Marker for Early Prediction of Severity, Necrosis, Organ Failure and Mortality in Acute Pancreatitis: 2011 ACG Presidential Poster

Abstract

Purpose: To prospectively evaluate the role of serum D-Dimer (SDD) levels in determination of severity and hospital course of acute pancreatitis and correlate it with standard scoring systems. Methods: 70 consecutive patients (64% males, age 15-76 yrs) with acute pancreatitis were studied after an informed consent. Patients were stratified into mild & severe pancreatitis as per Atlanta criteria. Serum D-Dimer (SDD) levels were analyzed quantitatively at admission by immune turbidity method. RANSON, APACHE, BISAP & MOFS scores were calculated along with CRP levels. Patients were treated with supportive care including nutritional and organ support. Antibiotics and biliary, radiological and surgical interventions were considered as per clinical requirement. SDD levels were compared with standard parameters while analyzing severity and outcome of acute pancreatitis using SPSS v17.0. Results: The median levels of serum D-Dimer (SDD) were higher in patients with severe pancreatitis (49.75 μg/ml, n = 40) than in those with mild pancreatitis (16.50 μg/ml, n = 30, p<0.001). At a cut off of 12.10 μg/ml, SDD had a sensitivity of 95% and specificity of 97% in predicting severe pancreatitis (AUC = 0.975). The median SDD levels were higher with higher degree of necrosis (>50% = 50.68μg/ml, 30-50% = 43.44 μg/ml, <30% = 40.14 μg/ml and those without necrosis = 20.06μg/ml, p<0.001). The median SDD levels were higher in patients with organ failure than those without (47.44 μg/ml vs 16.48 μg/ml, p<0.001). Patients who developed fluid collections had higher SDD levels than those who did not (43.43 μg/ml vs 27.87 μg/ml, p<0.001). Patients who died had higher SDD levels than those who survived (54.93 μg/ml vs 30.64 μg/ml, p<0.001). Correlation of SDD levels using Pearson & Spearman bivariate analysis revealed good correlation (p<0.001) with CTSI (0.512), CRP (0.505), APACHE score (0.677), RANSON score (0.565), BISAP score (0.612) and MOFS score (0.687). Conclusion: Serum D-Dimer (SDD) level at admission is an effective predictor of severity of acute pancreatitis as well as of development of organ failure, necrosis and mortality. SDD correlated with APACHE, RANSON, BISAP & MOFS scores and serum CRP in predicting hospital course and outcome. We recommend SDD as a single marker as a predictor of severity of acute pancreatitis.