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.
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.
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.
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: firstname.lastname@example.org