Low antithrombin III flags organ failure risk in severe pancreatitis study

Patients with hypertriglyceridemia-associated acute pancreatitis whose blood shows both elevated D-dimer and reduced antithrombin III face a markedly higher frequency of organ failure during hospitalization, according to a retrospective cohort study published in BMC Gastroenterology. Among 418 patients with elevated D-dimer, organ failure occurred in 44 of 151 patients with reduced antithrombin III, a rate of 29.1 percent, compared with 25 of 267 patients, or 9.4 percent, whose antithrombin III levels were preserved. The association held after statistical adjustment for age, sex, D-dimer concentration, triglyceride level and the time elapsed between symptom onset and hospital admission.

The study, led by Guotong Wu and colleagues, drew on hospitalized patients treated between October 2020 and November 2025. Of 959 patients with complete admission measurements of both D-dimer and antithrombin III, 79, or 8.2 percent, developed organ failure during their hospital stay. D-dimer elevation was defined as a level above 0.55 mg/L fibrinogen equivalent units, and antithrombin III reduction as a level below 75 percent, both according to the local laboratory reference ranges. The primary outcome was organ failure at any point during hospitalization.

D-dimer is widely used in acute pancreatitis as a marker of coagulation and fibrinolytic activation, the processes by which the clotting system and the clot-dissolving system are switched on together during systemic inflammation. But a high D-dimer alone does not tell clinicians how much anticoagulant capacity the patient still has in reserve. Antithrombin III is one of the body’s principal endogenous anticoagulants, and a falling level may signal that this reserve is being consumed as coagulation activation progresses. The researchers therefore asked whether, among patients whose D-dimer was already elevated, a reduced antithrombin III level identified a subgroup at higher risk of organ failure.

To answer that question, the team used binary logistic regression restricted to the 418 patients with elevated D-dimer. The main model adjusted for age, sex, the natural logarithm of D-dimer, the natural logarithm of triglycerides, and the natural logarithm of the time from symptom onset to admission plus one. In that fully adjusted model, reduced antithrombin III remained associated with organ failure, with an odds ratio of 3.30 and a 95 percent confidence interval of 1.86 to 5.85, and a P value below 0.001. In other words, after accounting for the other measured factors, patients with reduced antithrombin III had roughly three times the odds of experiencing organ failure during hospitalization compared with those whose levels were preserved.

Because the study spanned more than five years, the investigators also compared two admission periods. Patients admitted between 2020 and 2023 formed the earlier cohort and those admitted between 2024 and 2025 the later cohort. The observed event rates were similar across both periods: among patients with reduced antithrombin III, organ failure occurred in 27.8 percent of the earlier cohort and 31.5 percent of the later cohort, while among those with preserved antithrombin III the rates were 9.5 percent and 9.2 percent respectively. This consistency suggests the pattern was not an artifact of a single time period or a shift in clinical practice over the study window.

The authors caution, in effect, that the findings are observational. A retrospective cohort design can identify associations but cannot prove that reduced antithrombin III causes organ failure, and the analysis was limited to patients at the participating institutions who had both laboratory measurements available on admission. The odds ratio describes the association between the marker and the outcome within this specific population of hypertriglyceridemia-associated acute pancreatitis patients with elevated D-dimer, and it does not establish how the marker would perform in patients with other causes of pancreatitis or with normal D-dimer values.

The measurement of both D-dimer and antithrombin III is standard in most hospital laboratories, which is part of why the authors argue their findings support further evaluation of antithrombin III as a routinely available coagulation marker in this disease. If confirmed in prospective studies, a simple two-marker approach, using D-dimer to identify coagulation activation and antithrombin III to gauge the remaining anticoagulant reserve, could help clinicians recognize earlier which patients with hypertriglyceridemia-associated acute pancreatitis are at highest risk of organ failure. For now, the study establishes that within this patient group, the combination of elevated D-dimer and reduced antithrombin III identifies a subset with a substantially higher observed frequency of in-hospital organ failure, roughly 29 percent versus about 9 percent among those with preserved antithrombin III.

Subject of Research: The association between reduced antithrombin III and in-hospital organ failure in hypertriglyceridemia-associated acute pancreatitis patients with elevated D-dimer

Article Title: Reduced antithrombin III and in-hospital organ failure in hypertriglyceridemia-associated acute pancreatitis with elevated D-dimer: a retrospective cohort study

Article References: Wu, G., Qiao, Y., Pan, Z., Wang, X., Li, X., Wu, X., & Sun, Z. (2026). Reduced antithrombin III and in-hospital organ failure in hypertriglyceridemia-associated acute pancreatitis with elevated D-dimer: a retrospective cohort study. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05473-2

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05473-2

Keywords: acute pancreatitis, hypertriglyceridemia, antithrombin III, D-dimer, organ failure, coagulation, retrospective cohort study, risk stratification, BMC Gastroenterology, biomarkers, Reduced, antithrombin