The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen

BACKGROUND
A patient with acute abdominal pain requires rapid evaluation. In these patients, it is very important to distinguish between surgical and nonsurgical pathology. Our aim was to compare the accuracy of the leukocyte count and D-dimer test in the diagnosis of acute abdomen.
METHODS
In this prospective study, 225 patients admitted to the emergency unit due to nontraumatic acute abdomen between June 2006 and November 2007 were evaluated. The patients were divided into two groups: Group 1 patients who needed immediate laparotomy and Group 2 patients who did not. Age, gender, leukocyte count, D-dimer level, causes of acute abdominal pain, and operative findings were investigated. P values of <0.05 were considered statistically significant.
RESULTS
There was a positive correlation between the plasma D-dimer level and leukocyte count. D-dimer acted similarly to the leukocyte count in emergency abdominal conditions. The area under the receiver operating characteristic curve was statistically higher with the D-dimer test (p<0.0001). Additionally, in patients needing immediate laparotomy, the sensitivity of the D-dimer test was 95.7% versus 74.8% for leukocyte counts.
CONCLUSION
In a patient with acute abdomen, D-dimer test may be a strong alternative or an adjuvant to the leukocyte count.

Travma dýþý akut karýnlý hastalarýn tanýsýnda D-dimer testinin deðeri

AMAÇ
Akut karýnlý bir hasta hýzlýca deðerlendirilmeyi gerektirir. Bu hastalarda karýn aðrýsýnýn cerrahi bir nedenden mi yoksa cerrahi olmayan bir nedenden mi olduðunu anlamak çok önemlidir. Bu çalýþmada, akut karýn tanýsýnda lökosit sayýsýnýn ve D-dimer testinin doðruluðu karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Bu prospektif çalýþmada, Haziran 2006 ile Kasým 2007 tarihleri arasýnda travmaya baðlý olmayan akut karýn nedeniyle acil servise baþvuran 225 hasta deðerlendirildi. Hastalar iki gruba ayrýldý: grup 1 acil cerrahi giriþim gerektirenler ve grup 2 gerektirmeyenler. Yaþ, cinsiyet, lökosit sayýsý, D-dimer seviyesi, akut karýn aðrýsýnýn nedeni ve ameliyat bulgularý araþtýrýldý. P deðerlerinden 0,05’den küçük olanlar istatistiki olarak anlamlý kabul edildi.

BULGULAR
D-dimer seviyesi ve lökosit sayýsý arasýnda pozitif bir korelasyon bulundu. Acil karýn içi durumlarda D-dimer ve lökosit sayýsý benzer þekilde davrandý. ROC eðrisi altýnda kalan alan ise D-dimer testinde anlamlý olarak daha yüksekti (p<0,0001). Ek olarak, acil laparotomi gereken hastalarda bu testin duyarlýðý %95,7 iken lökosit sayýsýnýnki ise %74,8 olarak saptandý.
SONUÇ
Akut karýnlý bir hastada D-dimer testi lökosit sayýsýna güçlü bir alternatif veya yardýmcý olabilir.