Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.
BMC Gastroenterol. 2019 May 2;19(1):67. doi: 10.1186/s12876-019-0989-x.
Systemic alterations in coagulation are associated with complications of acute pancreatitis (AP). D-dimer, a fibrin degradation product, was recently described as a marker of pancreatitis outcome. Early prediction is essential for reducing mortality in AP. The present study aims to assess the relationship between elevated serum D-dimer levels and the severity of AP.
We performed an observational retrospective study with data from 3451 enrolled patients with AP. Serum D-dimer levels were measured upon admission, after 24 h and during the week after admission by immunoturbidimetry. Univariate and multivariate analyses were used to determine whether elevated D-dimer levels were independently associated with the severity of AP.
Of the 3451 AP patients, 2478 (71.8%) had serum D-dimer levels measured within 24 h of hospital admission; 1273 of these patients had D-dimer levels ≤2.5 mg/L, and 1205 had D-dimer levels > 2.5 mg/L (934 patients had mild AP (MAP); 1086, moderately severe AP (MSAP); and 458, severe AP (SAP)). Patients with D-dimer levels > 2.5 mg/L (n = 1205) had higher incidences of SAP (75.5% vs. 24.5%), acute peripancreatic fluid collection (APFC) (53.3% vs. 46.7%), acute necrotic collection (ANC) (72.4% vs. 27.6%), pancreatic necrosis (PN) (65.2% vs. 34.8%), infected pancreatic necrosis (IPN) (77.7% vs. 22.8%), organ failure (OF) (68.5% vs. 31.5%), persistent organ failure (POF) (75.5% vs. 24.5%), ICU requirement (70.2% vs. 29.8%), and mortality (79.2% vs. 20.8%) than did patients with D-dimer levels ≤2.5 mg/L (n = 1273). The multivariate analysis showed that patients with higher serum D-dimer levels had poorer prognoses that worsened over time.
The measurement of D-dimer levels at admission may be useful for risk stratification of AP.
凝血系统的改变与急性胰腺炎（AP）的并发症有关。D-二聚体，一种纤维蛋白降解产物，最近被描述为胰腺炎结局的标志物。早期预测对于降低 AP 的死亡率至关重要。本研究旨在评估血清 D-二聚体水平升高与 AP 严重程度之间的关系。
我们进行了一项观察性回顾性研究，纳入了 3451 名 AP 患者的数据。入院时、入院后 24 小时内和入院后一周内通过免疫比浊法测量血清 D-二聚体水平。使用单变量和多变量分析来确定升高的 D-二聚体水平是否与 AP 的严重程度独立相关。
在 3451 名 AP 患者中，有 2478 名（71.8%）在入院后 24 小时内测量了血清 D-二聚体水平；其中 1273 名患者的 D-二聚体水平≤2.5mg/L，1205 名患者的 D-二聚体水平>2.5mg/L（934 名患者为轻度胰腺炎（MAP）；1086 名中度严重胰腺炎（MSAP）；458 名严重胰腺炎（SAP））。D-二聚体水平>2.5mg/L（n=1205）的患者 SAP（75.5% vs. 24.5%）、急性胰周液体积聚（APFC）（53.3% vs. 46.7%）、急性坏死性积聚（ANC）（72.4% vs. 27.6%）、胰腺坏死（PN）（65.2% vs. 34.8%）、感染性胰腺坏死（IPN）（77.7% vs. 22.8%）、器官衰竭（OF）（68.5% vs. 31.5%）、持续性器官衰竭（POF）（75.5% vs. 24.5%）、需要 ICU（70.2% vs. 29.8%）和死亡率（79.2% vs. 20.8%）均高于 D-二聚体水平≤2.5mg/L（n=1273）的患者。多变量分析显示，血清 D-二聚体水平较高的患者预后较差，且随着时间的推移而恶化。
入院时测量 D-二聚体水平可能有助于对 AP 进行风险分层。
