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Medline ® Abstract for Reference 43

of 'Overview of intestinal ischemia in adults'

Coagulative disorders in human acute pancreatitis: role for the D-dimer.
Salomone T, Tosi P, Palareti G, Tomassetti P, Migliori M, Guariento A, Saieva C, Raiti C, Romboli M, Gullo L
Pancreas. 2003;26(2):111.
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, S. Orsola Hospital, Bologna, Italy.