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Turkish Journal of Medical Sciences

Abstract

Background/aim: Early risk stratification is required in cases of acute biliary pancreatitis (ABP). Traditional scoring systems such as Ranson’s criteria are complex and often delay treatment. D-dimer, a basic marker of systemic inflammation and coagulation, has shown promise as a prognostic tool. The present study investigates whether the predictive accuracy of serial serum D-dimer measurements is superior to that of the Ranson and BISAP scoring systems for moderate-to-severe ABP.

Materials and methods: Included in this single-center prospective observational study were 264 patients diagnosed with ABP between July 2022 and July 2025 whose collected data were analyzed. The participants were categorized as mild, moderate, or severe based on the current Revised Atlanta Classification (2012), and D-dimer levels were measured at admission (H0), 24 h (H24), and 48 h (H48), along with their BISAP scores to allow a comparative analysis.

Results: Mean D-dimer levels increased significantly with disease severity at all timepoints (p < 0.001). ROC analysis identified the D-dimer level at H48 to have the highest discriminative value for predicting moderate-to-severe ABP (AUC: 0.812; 95% CI: 0.758– 0.866). The H24 and H0 D-dimer levels also performed well (AUCs: 0.728 and 0.719, respectively). In comparison, the Ranson (H48 AUC: 0.741) and BISAP scores (H24 AUC: 0.755) yielded lower predictive accuracy – the H48 D-dimer AUC being statistically superior to both (p < 0.05).

Conclusion: Serum D-dimer levels are significantly associated with ABP severity and show promise as a practical, accessible, and cost-effective adjunctive biomarker for early risk assessment. Serial measurements, especially at 48 h, offer superior diagnostic accuracy compared to Ranson and BISAP scoring alone. The clinical measurement of D-dimer levels at 48 h can thus be considered an accessible and timely triage approach. Multicenter prospective validation studies are needed to confirm the diagnostic thresholds and to assess clinical integration.

Author ORCID Identifier

KEMAL TEKEŞİN: 0000-0002-1688-0597

TOLGA CANBAK: 0000-0002-2096-6975

AYLİN ACAR: 0000-0003-2378-4197

FATİH BAŞAK: 0000-0003-1854-7437

HASAN KUMRU: 0009-0005-8596-729X

OLGUN ERDEM: 0000-0003-1433-3431

DOI

10.55730/1300-0144.6106

Keywords

Acute pancreatitis, biomarker, BISAP score, D-dimer, disease severity, Ranson criteria

First Page

1480

Last Page

1486

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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