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Plasma D-dimer as a Prognostic Marker in ICU Admitted Egyptian Children with Traumatic Brain Injury
Hala Mohamed Amin Foaud1, John Rene Labib1, Hala Gabr Metwally1
1Faculty of Medicine, Department of Pediatrics, Cairo University , Egypt .
Insights
Evaluating D-dimer blood levels in children with traumatic brain injury (TBI) shows its potential as a prognostic marker. Low D-dimer levels indicate absence of brain injury and suggest a good outcome.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Hematology
Background:
- Traumatic brain injury (TBI) is a significant cause of childhood morbidity and mortality.
- Accurate prognostic markers are crucial for managing pediatric TBI.
- D-dimer, a marker of coagulation activation, is explored for its role in TBI.
Purpose of the Study:
- To evaluate plasma D-dimer levels as a novel prognostic marker in children with TBI.
- To assess the accuracy of D-dimer in predicting outcomes and survival in pediatric TBI cases.
Main Methods:
- A case-control study involving 46 pediatric TBI patients and 20 healthy controls.
- Prospective collection of clinical data and blood samples (including D-dimer) on days 1, 3, and 14 post-admission.
- Assessment of Glasgow Coma Scale (GCS), CT scans, and routine laboratory tests; ROC curve analysis for D-dimer's predictive ability.
Main Results:
- Significant differences in GCS, D-dimer, PT, and aPTT levels were observed between TBI cases and controls, and between survivors and non-survivors.
- D-dimer sensitivity decreased from 89.5% to 73.7%, and specificity from 100% to 81.5% over the study period.
- Survivors showed a significant decline in D-dimer levels (4.2 to 0.7), while non-survivors had a much higher initial D-dimer level with a slower decline (27.9 to 1.4).
Conclusions:
- Plasma D-dimer levels can differentiate between TBI patients and controls, and predict outcomes.
- Low plasma D-dimer levels are associated with the absence of brain injury and a favorable prognosis in children.
Background:
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. This study aimed at evaluation of the D-dimer blood levels as a new marker to predict prognosis and outcome of traumatic brain injuries among children.
Materials And Methods:
This case control study was conducted at the Paediatric Intensive Care Unit (ICU), Alharm Hospital in Giza, Egypt during 2012-2013, on 46 Paediatric cases admitted to ICU with head injury and 20 normal age-matched controls. Clinical data and venous blood samples were prospectively collected at 1(st), 3(rd) and 14(th) day of admission, in addition to examination finding as Glasgow coma scale (GCS), cranial brain computed tomography (CT), routine laboratory investigations (CBC, CRP, SGOT, SGPT, urea, creatinine, random blood glucose, Na, K and arterial blood gases) plasma D-dimer, INR, PT, aPTT and PC. Data analysis was carried out accordingly and ROC curve was performed to explore the discriminating ability of D-dimer through estimation of its accuracy in differentiating temporal survivorship of those with TBI.
Results:
Cases were classified according to outcome into survivors and non-survivors. Significant difference was observed between cases and controls and between survivors and non-survivors during 1(st), 3(rd) and 14(th) day of the follow up including GCS, blood levels of D-dimer, PT and aPTT. ROC curve analysis for D-dimer showed decline in both sensitivity from 89.5% to 73.7% and specificity from 100% to 81.5% along the study days respectively. D-dimer time measurements showed significant decline among survivors from 4.2 to 0.7, while in the non survivor group this decline was much higher from 27.9 to 1.4.
Conclusion:
Low plasma D-dimer suggests the absence of brain injury, and good prognosis.
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