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Plasma Fibrinogen and D-dimer in Children With Sepsis: A Single-Center Experience
Abhimanyu Sharma1, Meera Sikka1, Sunil Gomber2
1Dept. of Pathology, University College of Medical Sciences, Delhi, India.
Insights
In children with sepsis, D-dimer is a valuable early marker for disseminated intravascular coagulation (DIC). Measuring D-dimer in sepsis patients can aid in early identification and management of DIC, potentially improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Infectious diseases
Background:
- Sepsis induces a prothrombotic state due to enhanced fibrin formation and impaired degradation.
- Intravascular fibrin deposition is a hallmark of sepsis-induced coagulopathy.
- Early identification of disseminated intravascular coagulation (DIC) in sepsis is crucial for timely intervention.
Purpose of the Study:
- To evaluate coagulation parameters as early markers for DIC in children with suspected sepsis.
- To determine the diagnostic utility of D-dimer in pediatric sepsis-associated coagulopathy.
Main Methods:
- Prospective study of 50 children (1-10 years) with clinically suspected sepsis.
- Exclusion of patients on antibiotics prior to admission.
- Measurement of prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen, and D-dimer on admission, compared to 50 controls.
Main Results:
- D-dimer was positive in 72% of sepsis patients versus 0% in controls (P<0.01).
- Plasma fibrinogen levels were significantly higher in patients (P<0.01).
- PT and APTT were significantly prolonged in sepsis patients (P<0.01).
Conclusions:
- Elevated D-dimer levels in pediatric sepsis suggest its potential as an early indicator of DIC.
- Routine D-dimer measurement in sepsis can facilitate early DIC detection and management.
- Prompt DIC identification may improve prognosis with targeted coagulation-based therapies.
Background & Objective:
In sepsis, enhanced fibrin formation, impaired fibrin degradation, and intravascular fibrin deposition lead to a prothrombotic state. The current study aimed at measuring various coagulation parameters to predict an early marker for disseminated intravascular coagulation(DIC).
Methods:
The current prospective study was conducted from January 2012 to April 2013 on 50 children aged 1-10 years with clinically suspected sepsis referred to the Department of Pediatrics of a tertiary care center in New Delhi, India. Patients were evaluated in accordance with criteria for acute infection (ie, symptoms less than seven days) confirmed in all patients in the laboratory. Patients receiving antibiotics 24-48 hours preceding admission were excluded from the study. Prothrombin time, activated partial thromboplastin time, plasma fibrinogen, and D-dimer were measured at the time of admission in 50 patients and 50 controls.
Results & Conclusion:
D-dimer was positive in 36 (72%) patients and negative in all controls. The difference was statistically significant (P<0.01). Plasma fibrinogen was significantly (P<0.01) higher in patients compared with the controls. It was decreased in 6% and increased in 8% of the patients, and normal in all controls.PT and APTT were significantly (P<0.01) higher in patients compared with the controls.Though none of the current study patients developed overt disseminated intravascular coagulation, the high positivity for D-dimer suggested that it should be measured in children with sepsis for early identification of DIC. This can aid better management as additional coagulation based therapy such as recombinant anti-thrombin and thrombomodulin may help to improve prognosis.
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