Assessment of Quantitative D-dimer levels in Egyptian Patients with Budd-Chiari syndrome

Abstract

To fulfill the aim of the work, this study was designed to assess the level of quantitative D-dimer in patients with BCS and to identify the possibility of using it as a non invasive method in diagnosis of new thrombotic events. This study was conducted in Tropical Medicine Department, Ain Shams University, in the period from March 2013 till December 2013. We performed the current study on selected 40 cases of BCS divided into 2 groups: Group I; included patients with primary BCS. Group II; included patients with primary BCS with newly reported thrombotic event (including stent occlusion, DVT, PE ...etc). As well as a Control group that included 24 age & sex matched apparently healthy individuals. All patients were subjected to the following; careful history, thorough clinical examination and laboratory investigations [liver enzymes (AST and ALT), serum albumin, INR, total and direct bilirubin, complete blood picture, thrombophilia workup to clarify the underlying etiology of BCS. Quantitative D-dimer assay was measured for all cases & contacts. As well as, Abdominal Doppler ultrasonography, Magnetic resonance imaging (MRI) or multislice computerized tomography (C.T) and Direct venography if needed The results of the current study showed that BCS commonly occurs during the third decade of life and is more predominant in females. Regarding the etiology, we identified that FVLM was the most common cause and this was documented in 32.5% of patients. Most of patients enrolled in the study had an intermediate severity of liver dysfunction (Child B class). Concerning the clinical presentations of the studied group; abdominal enlargement was the most common symptom and hepatomegaly was the most common sign in the studied patients. Three patients (7.5%) had short segment of occlusion that enabled us to perform angioplasty with stenting. Twenty eight patients were not suited for angioplasty and had TIPS. From the twenty eight patients who underwent TIPS thirteen (46%) of them had patent stents (Group I), while the remaining fifteen (54%) had stent thrombosis (Group II). D-dimer levels were significantly higher in BCS patients who developed new thrombosis (Group II) than both control group and patients without other thrombi (Group I). The current study reveals that D-dimer serum level is a significant predictor for presence of thrombosis in the studied cases with Budd-Chiari syndrome. In the present work using a ROC curve, it was found that D-dimer cut-off point at 1.65 can be used as a predictor of new thrombosis with a sensitivity of 93.8% and a specificity of 87.5%. Hence, D-dimer level more than the cut-off value necessitate intense investigations for ongoing thrombus. Basal D-dimer level, done at the pre-intervention assessment, can be used to evaluate the type of stent which is going to be used in intervention. Post–intervention follow up of BCS patients can be done by measuring D-dimer levels periodically. The frequency of follow up and its duration are tailored according to the risk factors in each patient. Rising titer of D-dimer indicate more strict adjustment of anticoagulation.