Assessment of D-Dimers for the Early Prediction of Complications in Acute Pancreatitis

Gomercic, Cécile; Gelsi, Ève; Gysel, Damien van; Frin, Anne-Claire; Ouvrier, Delphine; Tonohouan, Marie; Antunès, Ophélie; Lombardi, L; Galleani, Laurianne De; Vanbiervliet, Geoffroy; Filippi, Jérôme; Schneider, Stéphane; Tran, Albert; Hébuterne, Xavier

doi:10.1097/mpa.0000000000000654

Cited by 22 publications

(20 citation statements)

References 24 publications

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“…However, there was no difference in Ranson scores between them (table XII, table XIII). This is consistent with the findings of Gomercic et al 19 who showed that the median D-dimer (2866 vs 1616 ng/ml, p<0.001) and CRP levels (107.3 vs 75.6 mg/l, p<0.001) were significantly higher in the complicated group and no difference in Ranson scores between the two groups.…”

Section: Discussionsupporting

confidence: 92%

“…Maeda et al 10 in their study reported sensitivity of 85% and specificity of 67% for D-dimer at hospital admission in predicting outcome of acute pancreatitis patients. In another study, Gomercic et al 19 found that D-dimer levels predict AP complications with good sensitivity (81% at 48 hours and 74% at 36 hours).…”

Section: Discussionmentioning

confidence: 96%

“…Gomercic et al 19 showed that the duration of hospitalization was higher for complicated AP (15.2 vs 7.5 days, P = 0.002).…”

Section: Discussionmentioning

confidence: 97%

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Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

Mamun¹,

Datta

Rahman

et al. 2019

Birdem Med J

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Background: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inflammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inflammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with the most severe forms but it remains a challenge to identify these poor prognosis cases specially in the first 48 hours. The objective of our study is to evaluate the efficacy of serum D-dimer in the prediction of severity and outcome of acute pancreatitis. Methods: This prospective and observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, Bangladesh from January, 2016 to September, 2017. Patients with acute pancreatitis admitted to Department of GHPD of BIRDEM General Hospital, Dhaka, were included in this study. Purposive type of non probability sampling technique was applied to enroll the patients. A predesigned structured questionnaire was used for recording the necessary information. Patients admitted with abdominal pain and fulfilling the diagnostic criteria of acute pancreatitis by clinical history, physical examination, biochemical tests and different imaging modalities and patients aged more than 18 years were included in this study. The patients were followed up on day 1, day 3 of admission and on the day before discharge. Results: Total 87 patients with acute pancreatitis, who fulfilled the inclusion criteria, were included in this study. This study found that 53(61.0%) had mild acute pancreatitis, 27(31.0%) patients had moderately severe acute pancreatitis and 7(8.0%) patients had severe acute pancreatitis. The mean serum D-dimer at day 1 of patients with mild disease was 2.31± 1.82(mean±SD) μg/ml, in patients with moderately severe disease was 4.67± 2.02(mean±SD) μg/ml and in severe acute pancreatitis it was 10.11±3.11 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). The mean serum D-dimer at day 3 of patients with mild disease was 0.8±0.51 (mean±SD) μg/ml, in patients with moderately severe disease was 1.86±2.22 (mean± SD) μg/ml and in severe acute pancreatitis it was 3.62±1.9 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). Thus serum D-dimer could predict disease severity early in the course of disease successfully. In the present study 55(63.2%) patients did not develop any kind of complications and serum D-dimer level at day 1 and day 3 were 2.4±1.73 and 0.81±0.49 respectively. On the other hand 32 (36.8%) patients developed complications and serum D-dimer level at day 1 and day 3 were 5.86±3.5 and 2.31±2.3 respectively. The difference among the groups were statistically significant (p<0.001).That reveals serum D-dimer is a predictor of outcome of acute pancreatitis. Sensitivity, specificity and accuracy was 77.8%, 76.5% and 77.0% respectively at day 1 (cut off value e”3.3 μg/ml) and it was 73.5%, 77.4% and 75.9% respectively at day 3 (cut off value e”1.05 μg/ml) in prediction outcome of AP. Conclusion: The difference of serum D-dimer levels between mild, moderately severe and severe acute pancreatitis was statistically significant and it was also higher in patients who developed complications following acute pancreatitis than those without complications. This simple, feasible and reproducible marker can be used in clinical practice to improve the early management of acute pancreatitis. Birdem Med J 2019; 9(1): 44-54

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

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Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

Mamun¹,

Datta

Rahman

et al. 2019

Birdem Med J

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“…Six18–24 (reported in seven publications) of the 19 included studies were US based. Of the 13 EU-5 studies, five3 25–28 were conducted in the UK, three each in Germany29–31 and Italy,32–34 and one each in France35 and Spain 36. Overall, most studies were of a retrospective design (13 studies),3 21–23 25–33 were based on single-centre hospitals (13)18–22 24–26 28 29 31 33 35 36 and were principally tertiary referral units for which the reporting was exclusively on patients with SAP (10) 22 23 25–31 33.…”

Section: Resultsmentioning

confidence: 99%

Moderately severe and severe acute pancreatitis : a systematic review of the outcomes in the USA and European Union-5

Sarri¹,

Guo²,

Iheanacho³

et al. 2019

BMJ Open Gastroenterol

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Background and objectivesThe global incidence of hospitalisation due to acute pancreatitis (AP) has been rising in the recent decades. In the USA alone, there was a 13.2% increase between 2009 and 2012 compared with 2002–2005. There remains a lack of approved treatments to prevent disease progression, leaving many liable to developing complications that include multisystem organ failure (OF) and death. This therapeutic deficit raises questions about the scale of the current burden of illness (BOI) associated with severe forms of AP. The aim of the systematic literature review (SLR) was to assess clinical, humanistic, and economic outcomes associated with moderately severe AP (MSAP) and severe AP (SAP) in the USA and the European Union-5 (EU-5).MethodsSystematic searches were conducted in MEDLINE and Embase to identify studies published in English (between 2007 and 2017) that reported on the BOI of MSAP and/or SAP. Manual searches of ‘grey’ literature sources were also conducted.ResultsThe SLR identified 19 studies which indicated that 15%–20% of patients with AP progress to more severe forms of the disease, up to 10.5% of those with SAP require surgery for complications, and up to 40% die during hospitalisation. By contrast, there appears to be a lack of data on the extent to which SAP affects patients’ quality of life.ConclusionThe available evidence clearly demonstrates that the current management for MSAP and SAP in the USA and EU-5 does not adequately meet patients’ needs. Early identification and intervention for AP is crucial, given the evidence of high rates of morbidity and an associated economic burden that is considerable. Since many patients with the condition present to hospitals at a point when multisystem OF or death is highly likely, there is a particularly urgent need for effective treatment options to prevent disease progression.

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“…This correlation was also confirmed in the 2011 survey data[10]. Similarly, patients with AP and disseminated intravascular coagulation or elevated D-dimer on admission were accompanied with a higher organ failure ratio and mortality rate[11,12]. We previously assessed the past nationwide survey data to identify any trends in the management of AP, and confirmed that the treatment strategy for late complications has shifted to less-invasive, step-up approaches in the last decade[13].…”

Section: Introductionmentioning

confidence: 64%

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

Hamada¹,

Masamune²,

Shimosegawa³

2017

WJG

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Treatment of acute pancreatitis (AP) is one of the critical challenges to the field of gastroenterology because of its high mortality rate and high medical costs associated with the treatment of severe cases. Early-phase treatments for AP have been optimized in Japan, and clinical guidelines have been provided. However, changes in early-phase treatments and the relationship between treatment strategy and clinical outcome remain unclear. Retrospective analysis of nationwide epidemiological data shows that time for AP diagnosis has shortened, and the amount of initial fluid resuscitation has increased over time, indicating the compliance with guidelines. In contrast, prophylactic use of broad-spectrum antibiotics has emerged. Despite the potential benefits of early enteral nutrition, its use is still limited. The roles of continuous regional arterial infusion in the improvement of prognosis and the prevention of late complications are uncertain. Furthermore, early-phase treatments have had little impact on late-phase complications, such as walled-off necrosis, surgery requirements and late (> 4 w) AP-related death. Based on these observations, early-phase treatments for AP in Japan have approached the optimal level, but late-phase complications have become concerning issues. Early-phase treatments and the therapeutic strategy for late-phase complications both need to be optimized based on firm clinical evidence and cost-effectiveness.

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Assessment of D-Dimers for the Early Prediction of Complications in Acute Pancreatitis

Abstract: D-Dimer levels were predictive of complications of AP as early as 36 hours after the onset of pain. This simple and reproducible marker might be useful in clinical practice to improve the early management of complicated AP.

Cited by 22 publications

References 24 publications

Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

Moderately severe and severe acute pancreatitis : a systematic review of the outcomes in the USA and European Union-5

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

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