Serial D-dimer measurements dynamically predict disease severity in acute biliary pancreatitis: a prospective...

Area of Science:

• Gastroenterology
• Hematology
• Clinical Diagnostics

Background:

• Acute biliary pancreatitis (ABP) requires early risk stratification for effective management.
• Traditional scoring systems like Ranson's criteria can be complex and delay treatment.
• D-dimer, a marker of inflammation and coagulation, shows prognostic potential.

Purpose of the Study:

• To investigate if serial serum D-dimer measurements predict moderate-to-severe acute biliary pancreatitis more accurately than Ranson and BISAP scores.
• To evaluate D-dimer's utility as an accessible biomarker for early risk assessment in ABP.

Main Methods:

• A single-center prospective observational study included 264 patients with ABP.
• Patients were classified by severity (mild, moderate, severe) using the Revised Atlanta Classification.
• Serum D-dimer levels were measured at admission (H0), 24 hours (H24), and 48 hours (H48); BISAP scores were also recorded for comparison.

Main Results:

• Mean D-dimer levels significantly correlated with ABP severity at all time points (p < 0.001).
• D-dimer at H48 demonstrated the highest predictive accuracy for moderate-to-severe ABP (AUC: 0.812), outperforming Ranson (H48 AUC: 0.741) and BISAP (H24 AUC: 0.755) scores.
• D-dimer levels at H24 and H0 also showed good predictive value (AUCs: 0.728 and 0.719, respectively).

Conclusions:

• Serum D-dimer levels are strongly associated with ABP severity and serve as a practical, cost-effective adjunctive biomarker.
• Serial D-dimer measurements, especially at 48 hours, provide superior diagnostic accuracy over Ranson and BISAP scores alone.
• Clinical measurement of D-dimer at 48 hours offers a timely and accessible triage approach for ABP risk assessment, warranting further multicenter validation.