Role of D-dimer in Predicting the Prognosis of Patients with Acute Pancreatitis_West China Medical Journal

Authors：

 ZhengZhaolian ^1,2 , GuoQiang ³ ,  HuWeiming ¹

1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. the First Department of Surgery, Fushun People's Hospital, Fushun, Sichuan 643200, P. R. China;
3. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HuWeiming, Email: rosebud-1@163.com

Keywords：

Acute pancreatitis; D-dimer; Infection; Organ failure; Death

DOI：

10.7507/1002-0179.201600417

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Objective To investigate the role of D-dimer in predicting the prognosis of the patients with acute pancreatitis (AP). Methods The medical records of 324 patients with a diagnosis of AP in West China Hospital from April to June 2014 were retrospectively analyzed. Results Overall mortality rate was 3%, the median hospital stay was (11±3) days, and the median Intensive Care Unit stay was (1±1) day. The prothrombin time, activated partial prothrombin time, fibrinogen, international normalized ratio, antithrombinⅢ, D-dimer, C-reactive protein, and procalitonin level in the organ failure (OF) patients were significantly higher than those in the non-OF patients (P<0.05). The D-dimer, C-reactive protein, and procalcitonin level in the patients with infection were significantly higher than those in the non-infectious onse (P<0.05). The D-dimer and procalcitonin level in the death group were significantly higher than those in the survivor group (P<0.05). D-dimer and procalcitonin level increased as the grade of AP increased (P<0.05); the difference in C-reactive protein between the light and middle type was not significant (P>0.05), while was significant between middle and severe, and light and severe (P<0.05). The area under the receiver operating characteristic curve (AUC) of OF predicted by D-dimer was higher than C-reactive protein and procalcitonin; AUC of infection predicted by D-dimer was lower than procalcitonin; AUC of death predicted by D-dimer was higher than C-reactive protein but lower than procalcitonin. Conclusion D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the complications and death of AP. D-dimer provide a more accurate assessment of prognosis than C-reactive protein and procalcitonin in patients with AP.

Citation： ZhengZhaolian, GuoQiang, HuWeiming. Role of D-dimer in Predicting the Prognosis of Patients with Acute Pancreatitis. West China Medical Journal, 2016, 31(9): 1530-1533. doi: 10.7507/1002-0179.201600417 Copy

1.	Andersson B, Appelgren B, Sjödin V, et al. Acute pancreatitis--costs for healthcare and loss of production[J]. Scand J Gastroenterol, 2013, 48(12):1459-1465.
2.	Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States:2012 update[J]. Gastroenterology, 2012, 143(5):1179-1187.e1-e3.
3.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111.
4.	Acevedo-Piedra NG, Moya-Hoyo N, Rey-Riveiro M, et al. Validation of the determinant-based classification and revision of the Atlanta classification systems for acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2014, 12(2):311-316.
5.	Nawaz H, Mounzer R, Yadav D, et al. Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients[J]. Am J Gastroenterol, 2013, 108(12):1911-1917.
6.	Petrov MS, Shanbhag S, Chakraborty MA, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis[J]. Gastroenterology, 2010, 139(3):813-820.
7.	Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis[J]. Gastroenterology, 2012, 142(7):1476-1482; quiz e15-e16.
8.	Rau BM, Kemppainen EA, Gumbs AA, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT):a prospective international multicenter study[J]. Ann Surg, 2007, 245(5):745-754.
9.	Radenkovic D, Bajec D, Ivancevic N, et al. D-dimer in acute pancreatitis:a new approach for an early assessment of organ failure[J]. Pancreas, 2009, 38(6):655-660.
10.	Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome[J]. Gastroenterology, 2011, 141(4):1254-1263.
11.	Takeda K, Mikami Y, Fukuyama S, et al. Pancreatic ischemia associated with vasospasm in the early phase of human acute necrotizing pancreatitis[J]. Pancreas, 2005, 30(1):40-49.
12.	Zhang XP, Li ZJ, Zhang J. Inflammatory mediators and microcirculatory disturbance in acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2009, 8(4):351-357.
13.	Kakafika A, Papadopoulos V, Mimidis K, et al. Coagulation, platelets, and acute pancreatitis[J]. Pancreas, 2007, 34(1):15-20.
14.	Osada J, Wereszczynska-Siemiatkowska U, Dabrowski A, et al. Platelet activation in acute pancreatitis[J]. Pancreas, 2012, 41(8):1319-1324.
15.	Abdulla A, Awla D, Hartman H, et al. Role of platelets in experimental acute pancreatitis[J]. Br J Surg, 2011, 98(1):93-103.
16.	Bradley EL. A clinically based classification system for acute pancreatitis[J]. Ann Chir, 1993, 47(6):537-541.
17.	Leser HG, Gross V, Scheibenbogen C, et al. Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis[J]. Gastroenterology, 1991, 101(3):782-785.
18.	Cardoso FS, Ricardo LB, Oliveira AM, et al. C-reactive protein prognostic accuracy in acute pancreatitis:timing of measurement and cutoff points[J]. Eur J Gastroenterol Hepatol, 2013, 25(7):784-789.

1. Andersson B, Appelgren B, Sjödin V, et al. Acute pancreatitis--costs for healthcare and loss of production[J]. Scand J Gastroenterol, 2013, 48(12):1459-1465.
2. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States:2012 update[J]. Gastroenterology, 2012, 143(5):1179-1187.e1-e3.
3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111.
4. Acevedo-Piedra NG, Moya-Hoyo N, Rey-Riveiro M, et al. Validation of the determinant-based classification and revision of the Atlanta classification systems for acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2014, 12(2):311-316.
5. Nawaz H, Mounzer R, Yadav D, et al. Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients[J]. Am J Gastroenterol, 2013, 108(12):1911-1917.
6. Petrov MS, Shanbhag S, Chakraborty MA, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis[J]. Gastroenterology, 2010, 139(3):813-820.
7. Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis[J]. Gastroenterology, 2012, 142(7):1476-1482; quiz e15-e16.
8. Rau BM, Kemppainen EA, Gumbs AA, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT):a prospective international multicenter study[J]. Ann Surg, 2007, 245(5):745-754.
9. Radenkovic D, Bajec D, Ivancevic N, et al. D-dimer in acute pancreatitis:a new approach for an early assessment of organ failure[J]. Pancreas, 2009, 38(6):655-660.
10. Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome[J]. Gastroenterology, 2011, 141(4):1254-1263.
11. Takeda K, Mikami Y, Fukuyama S, et al. Pancreatic ischemia associated with vasospasm in the early phase of human acute necrotizing pancreatitis[J]. Pancreas, 2005, 30(1):40-49.
12. Zhang XP, Li ZJ, Zhang J. Inflammatory mediators and microcirculatory disturbance in acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2009, 8(4):351-357.
13. Kakafika A, Papadopoulos V, Mimidis K, et al. Coagulation, platelets, and acute pancreatitis[J]. Pancreas, 2007, 34(1):15-20.
14. Osada J, Wereszczynska-Siemiatkowska U, Dabrowski A, et al. Platelet activation in acute pancreatitis[J]. Pancreas, 2012, 41(8):1319-1324.
15. Abdulla A, Awla D, Hartman H, et al. Role of platelets in experimental acute pancreatitis[J]. Br J Surg, 2011, 98(1):93-103.
16. Bradley EL. A clinically based classification system for acute pancreatitis[J]. Ann Chir, 1993, 47(6):537-541.
17. Leser HG, Gross V, Scheibenbogen C, et al. Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis[J]. Gastroenterology, 1991, 101(3):782-785.
18. Cardoso FS, Ricardo LB, Oliveira AM, et al. C-reactive protein prognostic accuracy in acute pancreatitis:timing of measurement and cutoff points[J]. Eur J Gastroenterol Hepatol, 2013, 25(7):784-789.

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Role of D-dimer in Predicting the Prognosis of Patients with Acute Pancreatitis

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