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Research Article: Association between peak D-dimer levels within 24?hours of admission and the risk of infected pancreatic necrosis in hyperlipidemic acute pancreatitis: a retrospective analysis

Date Published: 2026-08-25

Abstract:
The goal of this study is to analyze the relationship between the peak D-dimer levels measured within 24?h of admission and the risk of infected pancreatic necrosis (IPN) in patients with hyperlipidemic acute pancreatitis (HLAP) and to create and validate an early in-hospital risk stratification model of IPN. The study was conducted as a retrospective study on 286 HLAP patients from January 2023 – June 2025, divided into IPN ( n =?47) and non-IPN ( n =?239) groups. A separate time-validation group was collected ( n =?62) from July 2025 to December 2025. Multivariate logistic regression was used to identify independent risk factors for IPN and build the nomogram. The ROC curve, calibration curve, Hosmer-Lemeshow test, Delong test, and DCA were performed to evaluate model performance. Using restricted cubic spline (RCS), the dose–response relationship between D-dimer and IPN risk was evaluated. D-dimer, procalcitonin (PCT), MCTSI score, and persistent organ failure (POF) were independent risk factors for IPN (all p <?0.05). RCS analysis revealed a linear dose–response relationship between D-dimer and IPN risk (P for overall <0.001, P for nonlinear?=?0.119). The combined model incorporating D-dimer, PCT, MCTSI, and POF achieved an AUC of 0.82 (95% CI: 0.75–0.89), with sensitivity of 0.70, specificity of 0.82, and accuracy of 0.80. Calibration was good (Hosmer-Lemeshow p =?0.806), and DCA demonstrated clinical net benefit across threshold probabilities of 0.1–0.7. In the temporal validation cohort, the model yielded an AUC of 0.73 (95% CI: 0.56–0.89), with no significant difference from the derivation cohort ( p =?0.319). Given the limited sample size of the validation cohort and its single-center origin, these findings should be considered preliminary. Elevated peak D-dimer level within 24?h of admission is independently associated with an increased risk of IPN in HLAP patients in a linear positive manner. The early in-hospital risk stratification model comprised of D-dimer, PCT, MCTSI and POF demonstrates additionally good predictive performance, clinical utility and risk stratification during the early course of hospitalization for personalized treatment decision.

Introduction:
The incidence of hyperlipidemic acute pancreatitis (HLAP) has been rising year by year and has become one of the leading causes of acute pancreatitis ( 1 , 2 ). Compared with acute pancreatitis caused by other etiologies such as biliary tract diseases, patients with HLAP have the clinical characteristics of younger age at onset, more severe condition, and higher incidence of complications ( 3 ). Infectious pancreatic necrosis (IPN) is one of the most serious local complications of HLAP ( 4 ). The occurrence of IPN…

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