D-dimer as a Marker of Clinical Outcome in Children with Sepsis: A Tertiary Care Centre Experience

Abstract

Background: Emerging infections, sepsis, and disseminated intravascular coagulation (DIC) carry a high risk of morbidity and mortality in children. Elevated D-dimer levels indicate ongoing thrombosis and thrombolysis, which are hallmarks of DIC. Hence, D-dimer can be used as a prognostic marker in sepsis. Methods: A prospective single-center observational study was conducted at the Department of Pediatrics, Kasturba Medical College, Manipal. Children aged between 1 month and 18 years with sepsis were included to determine the level of D-dimer and to correlate D-dimer levels with outcomes. Results: Among the 80 consecutive children included in the study, the incidence of sepsis was highest in the 1 month to 6 years age group (55%). Lower respiratory tract infection (LRTI) was the most common etiology (25%) for sepsis. D-dimer was elevated in 64 out of 80 children (80%), and C-reactive protein (CRP) was elevated in 66 children (82%). About 6 children with sepsis had multi-organ dysfunction, with D-dimer elevated in 4 of these children. Three patients (4%) succumbed in our cohort. When elevated D-dimer levels were compared with the primary outcomes, statistical significance was not found. However, elevated D-dimer was found to be fairly sensitive (74 - 85%) in predicting outcomes, though with poor specificity. Data were analyzed using the Statistical Package for the Social Sciences version 23. The mean ± standard deviation, median, and interquartile ranges were used based on the normality of data. The chi-square test/Fisher’s exact test and Mann-Whitney tests were used for the analysis of categorical and continuous-discrete data, respectively, to determine statistical significance. Conclusions: This study reiterates that D-dimer is a sensitive tool for identifying various outcome parameters, though not statistically significant.