Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 9, 2022; 11(3): 139-148
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.139
Plasma D-dimer level in early and late-onset neonatal sepsis
Mohammed Al-Biltagi, Ehab M Hantash, Mohammed Ramadan El-Shanshory, Enayat Aly Badr, Mohamed Zahra, Manar Hany Anwar
Mohammed Al-Biltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, Bahrain, Dr. Sulaiman Al Habib Medical Group, KSA, Manama 26671, Manama, Bahrain
Ehab M Hantash, Department of Anatomy, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
Ehab M Hantash, Neonatology Unit, Department of Pediatrics, Dr. Sulaiman Al Habib Medical Group, Riyadh 11636, Riyadh, Saudi Arabia
Mohammed Ramadan El-Shanshory, Department of Pediatrics, Hematol Unit, Tanta University, Faculty of Medicine, Tanta 31511, Algharbia, Egypt
Enayat Aly Badr, Mohamed Zahra, Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
Manar Hany Anwar, Department of Clinical Pathology, Ministry of Health, Egypt, Tanta 31511, Alghrabia, Egypt
Author contributions: Anwar MH and El-Shanshory MR performed the clinical work and collected the data; Badr EA and Zahara MK performed the laboratory part; Hantash EM did the statistical analysis; Al-Biltagi M analyzed the data and wrote the manuscript; and All the authors revised and agreed to the final version of the manuscript.
Institutional review board statement: We performed the study according to the latest version of Helsinki's Declaration. The Institutional Ethical and Research Review Board of the Faculty of Medicine, Tanta University, approved the study.
Informed consent statement: All parents, guardians, or next of kin signed informed consent for the minors to participate in this study.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, Medical Complex, AlBahr Street, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com
Received: December 23, 2021
Peer-review started: December 23, 2021
First decision: March 7, 2022
Revised: March 9, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 9, 2022
Processing time: 134 Days and 22.3 Hours
Abstract
BACKGROUND

Neonatal sepsis is a life-threatening disease. Early diagnosis is essential, but no single marker of infection has been identified. Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin. D-dimer test reflects the activation of the coagulation system.

AIM

To assess the D-dimer plasma level, elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.

METHODS

The study was a prospective cross-sectional study that included ninety neonates; divided into three groups: Group I: Early-onset sepsis (EOS); Group II: Late-onset sepsis (LOS); and Group III: Control group. We diagnosed neonatal sepsis according to our protocol. C-reactive protein (CRP) and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.

RESULTS

D-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer. Neonates with LOS had substantially higher levels of D-dimer than EOS, with no significant differences in CRP. Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS (P < 0.01). Gram-negative bacteria have the highest D-dimer levels (Acinetobacter, Klebsiella, and Pseudomonas) and CRP (Serratia, Klebsiella, and Pseudomonas); while gram-positive sepsis was associated with relatively lower levels. D-dimer had a significant negative correlation with hemoglobin level and platelet count; and a significant positive correlation with CRP, hospitalization duration, and mortality rates. The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L, giving a sensitivity of 72.7% and specificity of 86.7%. The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.

CONCLUSION

The current study revealed a significant diagnostic value for D-dimer in neonatal sepsis. D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.

Keywords: Early-onset neonatal sepsis; Late-onset neonatal sepsis; C-reactive protein; D-dimer

Core Tip: The study aimed to define the diagnostic and prognostic value of the D-dimer assay in early and late-onset sepsis. We prospectively studied C-reactive protein and D-dimer levels in 90 neonates divided into control, Early-onset sepsis, and late-onset sepsis. D-dimer was significantly higher in the septic groups, more in late-onset than early-onset sepsis, and with gram-negative sepsis than gram-positive sepsis. The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L, giving a sensitivity of 72.7% and specificity of 86.7%.