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Prognostic value of baseline plasma D-dimer levels in sepsis: a prospective cohort study

Xiaoxiao Qu1, Shishi Wang1, Xuanmei Ye1

  • 1Department of Clinical Laboratory, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.

Practical Laboratory Medicine
|September 2, 2025
PubMed

Insights

Plasma D-dimer levels at admission predict 30-day mortality and septic shock in sepsis patients. Higher D-dimer indicates increased risk, aiding early sepsis management and risk stratification.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Biomarkers

Background:

  • Plasma D-dimer, a fibrin degradation product, indicates coagulation activation and is often elevated in critically ill patients.
  • The prognostic value of D-dimer for short-term outcomes in sepsis is not well-established.

Purpose of the Study:

  • To investigate the prognostic significance of plasma D-dimer levels for short-term outcomes in adult ICU patients with sepsis.
  • To determine if D-dimer can serve as an early biomarker for risk stratification in sepsis management.

Main Methods:

  • A prospective cohort study included 175 adult ICU patients diagnosed with sepsis (Sepsis-3 criteria).
  • Plasma D-dimer levels were measured at ICU admission and daily for five days.
  • Outcomes assessed were 30-day all-cause mortality and in-hospital septic shock, analyzed using Cox regression and Kaplan-Meier analysis.

Main Results:

  • Elevated admission D-dimer levels were significantly associated with increased risks of 30-day mortality and septic shock.
  • Each 1 μg/mL increase in D-dimer correlated with a 6% higher mortality risk (HR=1.06) and an 8% higher septic shock risk (HR=1.08).
  • Patients in the highest D-dimer quartile exhibited the worst outcomes, with a significant interaction observed between D-dimer and serum amyloid A (SAA) for mortality.

Conclusions:

  • Baseline plasma D-dimer levels independently predict 30-day mortality and septic shock in sepsis patients.
  • D-dimer shows potential as a valuable early biomarker for risk stratification in sepsis management.
  • Further research may explore D-dimer's role in guiding therapeutic interventions for sepsis.
Abstract

Keywords:
All-cause mortalityD-dimerIntensive care unitPrognostic biomarkerProspective cohort studySepsisSeptic shock

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