D-Dimer in Acute Mesenteric Venous Thrombosis: A Prospective Case-Control International Multicenter Study

Area of Science:

• Vascular Surgery
• Gastroenterology
• Emergency Medicine

Background:

• Acute mesenteric venous thrombosis (MVT) is a rare primary diagnosis in emergency settings.
• MVT carries a significant in-hospital mortality rate exceeding 20%.

Purpose of the Study:

• To identify distinct clinical and laboratory markers differentiating acute MVT patients from those with suspected but unconfirmed acute mesenteric ischemia (AMI).

Main Methods:

• Utilized data from the international, multicenter AMESI (Acute MESenteric Ischaemia) prospective case-control study.
• Employed multivariable logistic regression to identify independent factors associated with acute MVT.
• Analyzed D-dimer levels and other covariates including BMI, atherosclerotic disease, history of venous thromboembolism, and CRP.

Main Results:

• D-dimer levels were not significantly higher in MVT patients compared to non-AMI controls (median 7.0 mg/L vs. 4.5 mg/L, P = .092).
• Absence of atherosclerotic disease (OR 0.096) and elevated D-dimer (OR 2.59 per SD increment) were independently associated with MVT (P = .034).
• The receiver operating characteristic analysis showed a poor discriminative ability for D-dimer in diagnosing MVT (Area Under Curve = 0.63).

Conclusions:

• Elevated D-dimer shows an association with MVT but possesses limited diagnostic power.
• There is an urgent clinical need for the development of more accurate plasma biomarkers for diagnosing MVT.