Tabassum Nasrin, Nargis Akhtar, Nandita Ghosh, Harasit Kumar Paul.
Correlation of plasma D-dimer concentration with severity of patients systemic sclerosis.
J Pak Assoc Derma Jan ;31(3):447-53.

Background: Systemic sclerosis is an autoimmune disorder of the connective tissue characterized by microvascular occlusion and fibrosis leading to progressive organ damage. Patients’ with Systemic sclerosis may have a pro-coagulant state and impaired fibrinolysis. D-dimer is useful for the diagnostic evaluation of several thrombotic disorders. Patients’ with Systemic sclerosis are characterized by increased plasma D-dimer values reflecting a potential activation of both the coagulation and fibrinolytic pathways, which might finally predispose these patients to thrombotic complications. Objective:  To find out the relationship between the level of plasma D-dimer concentration and severity of systemic sclerosis. Methods: This cross-sectional study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September, 2015 to August, 2017. Forty four patients of systemic sclerosis were included in this study through consecutive sampling. All of the patients were diagnosed by the dermatologist as Systemic sclerosis on the basis of American College of Rheumatology (ACR) criteria. Using modified Rodnan Skin Scoring (mRSS) the patients were divided into three groups: mild, moderate and severe. All the patients in each group were tested for plasma D- dimer concentration and then plasma D-dimer concentration was correlated with the severity of disease. Statistical analysis was done by using Windows based computer software devised with statistical package for social sciences (SPSS-22, inc Chicago IL, USA). The results were obtained by using t-test, Chi-square test, ANOVA and Pearson’s Correlation Coefficient test. Results: Among 44 patients, 21(47.7%) had Diffuse Cutaneous Systemic Sclerosis (dcSSc) and 23 (52.3%) had Limited Cutaneous Systemic Sclerosis (lcSSc). According to mRSS 23 (52.3%) patients had mild, 15 (34.1%) had moderate and 6 (13.6%) had severe disease. Female patients were predominant in this study. D-dimer concentrations were increased in parallel with severity of the disease. Significant positive correlation was observed between D-dimer concentration and mRSS (p=0.009). Mean plasma D-dimer concentrations found to be significantly increased in patients with dcSSc in comparison with lcSSc (1.31±0.95 vs 0.78±0.37, p = 0.018).Conclusion: Plasma D-dimer concentration is directly related to the severity of the systemic sclerosis and it might be a helpful additional test to identify patients with systemic sclerosis at risk of developing thrombotic complications.

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