Serial D-dimer measurements dynamically predict disease severity in acute biliary pancreatitis: a prospective observational study

TL;DR

Measuring D-dimer levels at 48 hours helps predict severity in acute biliary pancreatitis better than traditional scoring systems.

Contribution

Serial D-dimer measurements, especially at 48 hours, show superior accuracy for predicting disease severity in acute biliary pancreatitis.

Findings

D-dimer levels at 48 hours had the highest accuracy (AUC: 0.812) for predicting moderate-to-severe ABP.

D-dimer measurements outperformed Ranson and BISAP scoring systems in predicting disease severity.

Serial D-dimer measurements are practical, accessible, and cost-effective for early risk assessment.

Abstract

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.

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.

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).

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.

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