d-Dimer in patients with suspected acute mesenteric ischemia

Objectives

The aims of this study were to assess the diagnostic value of d-dimer in patients with suspected acute mesenteric ischemia (AMI) and to evaluate the correlation between d-dimer levels and the severity of bowel necrosis.

Methods

A prospective, noninterventional study of 67 patients with clinical suspicion of AMI was performed. Measurement of d-dimer levels was performed using a latex turbidimetric method.

Results

Acute mesenteric ischemia was diagnosed in 23 patients (34.3%) and non-AMI in 44 patients (65.7%). Median d-dimer levels on admission were 6.24 μg fibrinogen equivalent units (FEU)/mL (range, 0.96-53.48 μg FEU/mL) in patients with AMI and 3.45 μg FEU/mL (range, 0.50-44.69 μg FEU/mL) in non-AMI patients (P = .064). d-Dimer had poor discriminative value to differentiate the presence from the absence of AMI with an area under the receiver operating characteristic curve of 0.64 (95% confidence interval, 0.50-0.78). A serum d-dimer cutoff value of 1.0 μg FEU/mL had a sensitivity of 96%, a specificity of 18%, a positive likelihood ratio of 1.17, and a negative likelihood ratio of 0.24. Among patients with AMI verified at operation, 8 had resectable bowl necrosis and 9 had unresectable bowel necrosis. There was no difference in serum d-dimer levels between resectable and unresectable bowel necrosis (P = .665).

Conclusions

Detection of serum d-dimer could not help to differentiate patient with AMI from those with non-AMI. We did not find a correlation between serum d-dimer levels and the severity of AMI. However, measurement of d-dimer levels can be of value for a small decrease in the likelihood of AMI, when the result is low.