D-dimer: a biomarker for predicting disease severity and outcome in hospitalized children with COVID-19 and post COVID multisystem inflammatory syndrome

Authors

  • Nazish Saqlain Department of Hematology and Transfusion Medicine, UCHS, The Children’s Hospital, Lahore, Pakistan
  • Attia Bari Department of Pediatric Medicine, UCHS, The Children’s Hospital, Lahore, Pakistan
  • Aimen C. Department of Pediatric Medicine, UCHS, The Children’s Hospital, Lahore, Pakistan
  • Masood Sadiq Department of Pediatric Cardiology, UCHS, The Children's Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.18203/2349-3291.ijcp20231837

Keywords:

COVID-19, SARS-CoV-2, D-Dimer, Children, Acute respiratory disease

Abstract

Background: COVID-19 has presented with varied signs and symptoms with raised inflammatory markers among which D-dimers have been highlighted right from the beginning. Objectives were to analyze the relationship of D-dimers with the disease severity and outcome of children with COVID-19 and MIS-C in a developing country. 

Methods: It was a retrospective study conducted at a pediatric tertiary care hospital from March 2020 to November 2021. Clinical and laboratory details of confirmed COVID-19 and post COVID-19 MIS-C cases were recorded. D-dimer testing was performed using Chemiluminescence technique. It’s relation with disease severity and predictive role for in-hospital mortality were established by using ROC curves and cut-off values were calculated by using SPSS-24.

Results: Of 272 children, 182 were of COVID-19 and 90 were of MIS-C. The mean age for COVID-19 and MIS-C patients was 5.4±4.8 years and 6.4±3.5 years respectively. Mild disease was seen in 33% cases while 17.6% were critical and 56.2% had some under lying comorbidity at presentation. Mean D-dimers were significantly higher in children with severe disease, who required ICU admission and non-survivors as compared to those with mild or moderate disease, not requiring ICU care and survivors, both in COVID-19 and MIS-C patients. ROC curve identified D-dimer value of ≥4.58 µg/ml (AUC=0.845) for COVID-19 cases and ≥4.73 µg/ml (AUC=0.682) for MIS-C patients as predictive of mortality.

Conclusions: Raised D-dimer level is a reliable predictor of disease severity and outcome in children with COVID-19 and MIS-C. The D-dimer value of 4.58 µg/ml for COVID-19 cases and 4.73µg/ml for MIS-C patients was found to be the cut-off levels for predicting mortality

Metrics

Metrics Loading ...

References

Zheng J. SARS-coV-2: An emerging coronavirus that causes a global threat. Int J Biol Sci. 2020;16(10):1678-85.

Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;1.

Sun K, Chen J, Viboud C. Early epidemiological analysis of the coronavirus disease 2019 outbreak based on crowdsourced data: a population-level observational study. Lancet Digit Heal. 2020;10.

Ji L-N, Chao S, Wang Y-J, Li X-J, Mu X-D, Lin M-G, et al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World J Pediatr. 2020;1-2.

Sadiq M, Aziz OA, Kazmi U, Hyder N, Sarwar M, Sultana N, et al. Multisystem inflammatory syndrome associated with COVID-19 in children in Pakistan The. Lancet child Adolesc Heal. Elsevier Ltd; 2020;4642(20):19-20.

Michael B, Benoit SW, Helena M, Oliveira S De, Chin W, Benoit J, et al. Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review. Clin Biochem. 2020;81(1):1-8.

Yun H, Sun Z, Wu J, Tang A, Hu M, Xiang Z. Laboratory data analysis of novel coronavirus (COVID-19) screening in 2510 patients. Clin Chim Acta. 2020;507:94-7.

Saleh M, Alkofide A, Alshammari A, Siddiqui K, Owaidah T. Changes in Hematological , Clinical and Laboratory Parameters for Children with COVID-19 : Single-Center Experience. J Blood Med. 2021;819-26.

Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. J Intensive Care. J Intensive Care. 2020;8(1):1-11.

Rostami A, Sepidarkish M, Lee MMG, Riahi SM, Shiadeh MN, Esfandyari S, et al. SARS-CoV-2 seroprevalence worldwide : a systematic review and. Clin Microbiol Infect. 2021;27(3):331-40.

WHO. Clinical Management of COVID-19: Interim Guidance, 27 May 2020. World Health Organization. 2020. Available at: https://apps.who.int/iris/ bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf. Accessed on 25 March, 2023.

Saqlain N, Mazher N, Bari A, Ch. A, Farhan S, Ahmed N. Association of elevated D-dimers with severity and outcome of COVID-19 infection in children. Research and practice in Thrombosis and Haemostasis. 2021;5(SUPPL 2).

Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children. 2020;7(7):69.

Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr Pulmonol. 2020;55(10):2565-75.

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6):e20200702.

Castagnoli R, Votto M, Licari A. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020;1-10.

Zabeida A, Winikoff R, Pelland-Marcotte MC, Charlebois J, Sabapathy C. COVID-19-associated coagulopathy in children: A multicenter observational cohort study. Pediatr Blood Cancer. 2023;70(1):e30079.

Bansal A, Singh AD, Jain V, Aggarwal M, Gupta S, Padappayil RP, et al. The association of D-dimers with mortality, intensive care unit admission or acute respiratory distress syndrome in patients hospitalized with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Heart Lung. 2021;50(1):9-12.

Shoar S. D-dimer and poor clinical outcome in patients with COVID-19: lessons from meta-analysis of case-control studies. Heart Lung. 2021;50(2):298.

Nugroho J, Wardhana A, Maghfirah I, Mulia EPB, Rachmi DA, A'yun MQ, Septianda I. Relationship of D-dimer with severity and mortality in SARS-CoV-2 patients : A meta-analysis. Int J Lab Hematol. 2021;43(1):110-5.

Velavan TP, Meyer CG. Mild versus severe COVID-19: laboratory markers. Int J Infec Dis. 2020;95:304–7

Tang N, Li D, Wang X. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thrombosis Haemostasis. 2020;18:844-7.

Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet . 2020;395:497-506.

Ozen M, Yilmaz A, Cakmak V, Beyoglu R, Oskay A, Seyit M, Senol H. D-Dimer as a potential biomarker for disease severity in COVID-19. Am J Emerg Med. 2021;40:55-9.

Al-Ghafry M, Vagrecha A, Malik M, Levine C, Uster E, Aygun B, et al. Multisystem inflammatory syndrome in children (MIS-C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS-C cohort. J Thromb Haemost. 2021;19(7):1764-70.

Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS one. 2021;16(8):e0256744.

Buonsenso D, Mariani F, Pierri L, Morello R, Yock-Corrales A, Del Aguila O, et al. Association between Coagulation Profile and Clinical Outcome in Children with SARS-CoV-2 Infection or MIS-C: A Multicenter Cross-Sectional Study. Children. 2022;9:279.

McArdle AJ, Vito O, Patel H, Seaby EG, Shah P, Wilson C, et al. Treatment of Multisystem Inflammatory Syndrome in Children. N Engl J Med. 2021;385:11-22.

Downloads

Published

2023-06-27

How to Cite

Saqlain, N., Bari, A., C., A., & Sadiq, M. (2023). D-dimer: a biomarker for predicting disease severity and outcome in hospitalized children with COVID-19 and post COVID multisystem inflammatory syndrome. International Journal of Contemporary Pediatrics, 10(7), 995–1001. https://doi.org/10.18203/2349-3291.ijcp20231837

Issue

Section

Original Research Articles