D-Dimer in Acute Mesenteric Venous Thrombosis: A Prospective Case-Control International Multicenter Study

Abstract

Background: Acute mesenteric venous thrombosis (MVT) is rarely suspected as primary diagnosis in emergency departments and still carries an in-hospital mortality rate of above 20%.

Objectives: The aim of this study was to find differences in clinical and laboratory markers between patients with acute MVT and a control group of suspected but confirmed as not having any type of acute mesenteric ischaemia (AMI).

Design: Data was retrieved from the AMESI (Acute MESenteric Ischaemia) study. This international, multicenter prospective case-control study from 32 sites collected data on patients with suspected AMI during a 10-month period.

Methods: Independent factors associated with acute MVT were evaluated in a multivariable logistic regression analysis and expressed as odds ratios (OR) with 95% confidence intervals (CI).

Results: D-dimer was not significantly higher in MVT (n = 73) compared to non-AMI (n = 287) patients (median 7.0 mg/L vs 4.5 mg/L, P = .092). After entering BMI, atherosclerotic disease, history of venous thromboembolism, CRP, and D-dimer as covariates in a multi-variable logistic regression analysis, absence of atherosclerotic disease (OR 0.096, 95% CI 0.011-0.84; P = .034) and elevated D-dimer (OR 2.59/one SD increment, 95% CI 1.07-6.28; P = .034) were associated with MVT. The discriminative ability of D-dimer for MVT as assessed by area under the curve in the receiver operating characteristics analysis was 0.63 (95% CI 0.49-0.78).

Conclusion: Elevated D-dimer was associated with MVT, but the discriminative ability of D-dimer was poor. There is an urgent need to find a more accurate plasma biomarker for this condition.

Trial registration: NCT05218863 (registered 19.01.2022).

Keywords: D-dimer; Mesenteric venous thrombosis; diagnosis; suspected acute mesenteric ischaemia.

Figure 1.

Flow chart of included study patients.

Figure 2.

Box plot graph showing plasma lactate levels in time intervals prior to diagnosis. Temporal plasma lactate values prior to diagnosis of acute MVT versus non-AMI (acute mesenteric ischaemia) patients. Box plot graph showing median and interquartile range values of plasma lactate at different time ranges before diagnosis of acute MVT and non-AMI patients. The line across the box indicates the median, the box represents interquartile range, and the whiskers are lines that extend from the box edges to the highest and lowest values, excluding outliers. Values more than 1.5 IQR’s but less than 3 IQR’s (o), and more than 3 IQR’s (*), from the box edges are labelled as outliers and extremes, respectively