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Coagulative Disorders in Human Acute Pancreatitis: Role for the D-Dimer

Salomone, Teresa*; Tosi, Patrizia§; Palareti, Gualtiero†; Tomassetti, Paola∥; Migliori, Marina∥; Guariento, Aurelia‡; Saieva, Calogero¶; Raiti, Carlo*; Romboli, Maurizio‡; Gullo, Lucio∥

Article

Introduction and aims: We investigated coagulative disorders, particularly the role of the D-dimer, in acute pancreatitis where coagulation abnormalities related to disease severity are known to occur.

Methodology: D-dimer levels in 30 patients with acute pancreatitis were evaluated; pancreatitis was mild and uncomplicated in 11 patients, accompanied by complications in 15, and severe in 4. We attempted to find a relationship between the D-dimer level and the antithrombin III level, prothrombin time, partial thromboplastin time, the C-reactive protein level, and results of routine laboratory tests.

Results: In the 11 patients with uncomplicated pancreatitis, the D-dimer level increased about 1.5 times over the limit, while in the 15 patients with complications and the four patients with severe pancreatitis, the D-dimer level increased about seven times above the normal limit; this difference was highly significant (p < 0.0001). The rise in the D-dimer level was inversely related to albumin and calcium levels (p = 0.0001) and directly related to the C-reactive protein level, fibrinogen level and leukocyte count (p = 0.0001), prothrombin time (p = 0.006), partial thromboplastin time (p = 0.03), and acute abdominal collections and lung involvement (p = 0.0001). The increase appeared early on, lasting for the entire study and peaking on days 3–6.

Conclusions: The D-dimer is the expression of pancreatitis and the extension of systemic involvement; it may be considered a prominent link in the chain of events leading to severe disease.

*Emergency Department, †Institute of Angiology and Coagulative Disorders, and ‡Central Laboratory, S. Orsola Hospital, Bologna, §Institute of Hematology and Medical Oncology “Séragnoli” and Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, and ¶Epidemiology Unit CSPO, Firenze, Italy

Manuscript received February 15, 2002;

revised manuscript accepted July 23, 2002.

Address correspondence and reprint requests to Dr. Patrizia Tosi, Institute of Hematology and Medical Oncology “Séragnoli,” Policlinico S. Orsola, Via. Massarenti, 9 40138 Bologna, Italy. E-mail: ptosi@med.unibo.it

© 2003 Lippincott Williams & Wilkins, Inc.