D-dimer diagnostic performance for splanchnic vein thrombosis: A systematic review

Objective This systematic review aimed to evaluate the diagnostic accuracy of D-dimer testing for splanchnic vein thrombosis (SVT), a clinical setting where its role remains uncertain due to confounders such as hepatic dysfunction and inflammation. Methods This review was registered on the Open Science Framework (https://osf.io/4pnr5) and conducted in accordance with PRISMA-DTA guidelines. PubMed and EMBASE were searched from inception through January 3, 2026. Studies evaluating D-dimer diagnostic accuracy for SVT, with imaging as the reference standard, were included. Methodological quality was assessed using QUADAS-2 and PROBAST. Data were synthesized narratively due to clinical and methodological heterogeneity. Results Twenty-five studies comprising 9,052 patients were included. Among the 14 studies with originally reported diagnostic metrics, sensitivity ranged from 54.5% to 95.3%, specificity from 33.0% to 96.0% and the area under the curve (AUC) from 0.615 to 0.982. Diagnostic performance varied notably by clinical context, with post-splenectomy AUC of 0.615–0.89, and cirrhosis AUC of 0.678–0.982. In cirrhotic patients, accuracy declined with worsening hepatic function (AUC of 0.809–0.963 in Child-Pugh class A versus 0.691–0.698 in class C). Optimal cut-off values varied widely (300–13,255 ng/mL), reflecting population and assay diversity. Multimarker models combining D-dimer with P-selectin or von Willebrand factor outperformed D-dimer alone (AUC of 0.807–0.975). Conclusions D-dimer demonstrates variable diagnostic accuracy for SVT, with performance markedly influenced by hepatic function and clinical setting. Current evidence does not support its use as a universal standalone rule-out test across the full spectrum of clinical settings, despite a high negative predictive value in selected low-risk populations. Multimarker approaches show promise but require prospective validation in well-designed studies.