title: Prognostic significance of D-dimer, natural anticoagulants and routine coagulation parameters in acute pancreatitis.
abstract: OBJECTIVE
  This study was conducted to assess the predictive value of coagulation abnormalities in determining disease severity and prognosis of acute pancreatitis (AP).
  
  
  METHODS
  Patients of AP and 25 healthy volunteers were included in this prospective observational study. The final outcomes were disease severity assessed by Computed Tomography Severity Index, Acute Physiological Assessment and Chronic Health Evaluation--II, presence of organ failure and mortality. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), fibrinogen, antithrombin-III (AT-III), protein-C, and protein-S levels were assessed on day 0, 3 and 7 of admission.
  
  
  RESULTS
  Of the 38 patients included, 13 died. Mean PT and TT were similar between patients and controls on any given day. PTT showed elevation on day 3 and 7 (p = 0.001) compared to controls, although fibrinogen and D-dimer were significantly higher in patients on all days. Protein C and AT-III were significantly lower in patients and more so in non survivors ( (p = 0.001)) than controls. Multiple logistic regression analysis revealed D-dimer levels > or = 400 - 800 ng/ml and AT- III level of < 71% at admission were associated with high mortality (OR 11.2, AUROC 0.70 and OR 16.6, AUROC 0.82 respectively) as well as predicted organ failure.
  
  
  CONCLUSIONS
  Serum D-dimer and antithrombin-III levels can be used to assess disease severity and predict outcome of patients with acute pancreatitis.
authors.affiliation: Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi - 110029, India.
authors.forename: Sukhbir Singh
authors.initials: SS
authors.lastname: Badhal
authors.forename: Subhadra
authors.initials: S
authors.lastname: Sharma
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
authors.forename: Asok Kumar
authors.initials: AK
authors.lastname: Mukhopadhyay
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D001779:Blood Coagulation Factors / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood*; D010314:Partial Thromboplastin Time; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism; D011517:Prothrombin Time; D012720:Severity of Illness Index; D013918:Thrombin Time
chemical_list: D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; D017293:Protein S; C036309:fibrin fragment D; D000990:Antithrombin III; D005340:Fibrinogen