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Evaluating Lactate and D-Dimer as Mortality Predictors of Paediatric Multiple Organ Dysfunction Syndrome: A
Phuong Minh Nguyen1, Khai Viet Tran1, Hung Viet Phan1
1Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam.
Insights
Lactate and D-dimer effectively predict mortality in paediatric Multiple Organ Dysfunction Syndrome (MODS), especially in low-resource settings. These biomarkers offer valuable insights for improving patient outcomes in critical care.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Mortality prediction
Background:
- Multiple Organ Dysfunction Syndrome (MODS) is a critical condition with high mortality.
- Limited data exists on mortality prediction in pediatric MODS, particularly in low-middle income countries.
- This study investigates lactate and D-dimer as potential mortality predictors in pediatric MODS.
Purpose of the Study:
- To evaluate the mortality predicting capabilities of lactate and D-dimer in pediatric patients with MODS.
- To assess the combined predictive power of lactate and D-dimer.
- To determine the utility of these biomarkers in resource-limited settings.
Main Methods:
- Prospective study of pediatric patients in a Vietnamese PICU (2019-2021).
- Assessment of lactate and D-dimer concentrations.
- Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow tests were used to evaluate discriminative ability and calibration.
Main Results:
- Mortality rate was 63.1% among studied patients.
- Significantly higher lactate and D-dimer levels were observed in non-survivors (P < 0.001).
- The combined lactate-D-dimer test showed the highest Area Under the Curve (AUC) of 0.804, indicating strong predictive capability.
Conclusions:
- Lactate and D-dimer demonstrate significant association with mortality in pediatric MODS.
- These biomarkers possess good discrimination and calibration abilities.
- Lactate and D-dimer are valuable predictors in resource-limited settings, potentially improving patient outcomes.
Background:
Multiple Organ Dysfunction Syndrome (MODS) is a complex medical condition characterised by dysfunction across multiple organs. With limited information available on mortality prediction in the paediatric population, particularly in low-middle income countries, this study evaluates the mortality predicting capabilities of lactate, D-dimer, and their combination.
Methods:
This prospective study involved paediatric patients admitted to the paediatric intensive care unit (PICU) of the largest central children's hospital in the Mekong Delta region, Vietnam, from 2019 to 2021. The discriminative ability and calibration of both individual and combined tests were assessed using the receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test.
Results:
Among the patients studied, 63.1% did not survive. Lactate and D-dimer concentrations were significantly higher in the non-survivor group (P < 0.001). The area under the curve (AUC) values for lactate, D-dimer and the combined lactate-D-dimer test were 0.742, 0.775 and 0.804, respectively, with the combination showing the highest AUC value, though without statistical significance. Specific thresholds for lactate, D-dimer and the combination yielded sensitivities of 75.5%, 71.7%, and 66.0%, respectively. All three tests showed no statistically significant differences between observed and predicted mortality in the Hosmer-Lemeshow test (all P-values > 0.05).
Conclusion:
Lactate and D-dimer levels showed a significant association with mortality, along with good discrimination and calibration abilities. These results highlight the utility of lactate and D-dimer as effective predictors in paediatric MODS, particularly in resource-limited settings, and their role in improving patient outcomes.
