D-dimer as a predictor of the need for laparotomy in patients with unclear non-traumatic acute abdomen. A preliminary study.
OBJECTIVE
The acute onset of intense abdominal pain requires rapid evaluation, and since D-dimer level is reported to be useful in the diagnosis of patients with suspected acute superior mesenteric artery occlusion, our aim was to evaluate the value of D-dimer testing in the diagnosis of acute surgical abdomen with no precise diagnosis.


METHODS
Between July 2004 and June 2006, 93 patients with acute abdomen who required surgical exploration without precise diagnosis were admitted to this prospective clinical study. After surgery, the patients were divided into two groups: group 1 (n=52), patients who needed immediate laparotomy, and group 2 (n=41), patients without the need for laparotomy. Blood samples were taken to analyse D-dimer, white blood cell count and pH level. P-values of <0.05 were considered statistically significant.


RESULTS
There was a positive correlation between the plasma D-dimer level and leucocyte count. Leucocyte counts > 16,800/mm3 (p < 0.01) and D-dimer levels >4.7 microg FEU/mL were more sensitive (p < 0.001). Sensitivity was 97.6% and specificity 61.5% for D-dimer level, and 82.9% and 42.3%, respectively, for leucocyte count. Metabolic acidosis at admission was the most important factor for mortality (p < 0.001).


CONCLUSIONS
In a patient with acute abdomen without precise diagnosis, a D-dimer level above the cut-off value (4.7 microg fibrinogen equivalent units/mL) may be an indicator with high sensitivity for surgical pathology requiring laparotomy.
Department of General Surgery, Erciyes University, Kayseri, Turkey. hyakyildiz@gmail.com
Hizir
H
Akyildiz
Alper
A
Akcan
Ahmet
A
Oztürk
Erdogan
E
Sozuer
Can
C
Kucuk
Akif
A
Yucel
D000006:Abdomen, Acute / Q000175:diagnosis / Q000601:surgery*; D000138:Acidosis / Q000175:diagnosis; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007813:Laparotomy / Q000706:statistics & numerical data*; D007958:Leukocyte Count; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D