d-dimer as a marker of clinical outcome in children with sepsis: a tertiary care centre experience

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.