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
ARTICLE HIGHLIGHTS
Research background

Neonatal sepsis is one of the critical conditions that put the life of neonates in danger. It is a severe systemic inflammatory response to blood-stream infections with significant neonatal morbidity and mortality. Early and proper diagnosis of neonatal sepsis is critical for timely-administered antibiotics, decreases the length of the hospital stay, and improves the prognosis, especially the neurodevelopmental outcome.

Research motivation

Early and proper diagnosis of neonatal sepsis is critical for appropriate and effective management with timely-administered antibiotics to decrease the hospitalization length and improve the prognosis, especially for the neurodevelopmental prospects.

Research objectives

We aimed to evaluate the significance of plasma D-dimer level in the early diagnosis of neonatal sepsis and elaborate on its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.

Research methods

The study was a prospective cross-sectional study that included ninety neonates; divided into early-onset sepsis (EOS) group (Group I), late-onset sepsis (LOS) group (Group II), and control group (Group III). We diagnosed neonatal sepsis according to our protocol. C-reactive protein (CRP) and D-dimer assay were compared and related to the causative microbiological agents.

Research results

D-dimer was significantly higher in septic groups. Septic groups showed a significantly higher number of cases with positive D-dimer. Neonates with LOS had considerably higher levels of D-dimer than EOS. At the same time, there were no significant differences in CRP levels in neonates with EOS or LOS. However, neonates with LOS had a significantly longer duration of hospitalization and higher mortality rates than neonates with EOS. The rate of gram-negative bacteremia was substantially higher in LOS than in EOS, while the rate of gram-positive bacteremia was significantly higher in EOS than in LOS (P < 0.01). Gram-negative bacteria have the highest D-dimer levels (Acinetobacter, Klebsiella, and Pseudomonas) and CRP (Serratia, Klebsiella, and Pseudomonas). On the other hand, gram-positive sepsis was associated with relatively lower levels of D-dimer and CRP. D-dimer had a significant negative correlation with hemoglobin level and platelet count while having a significant positive correlation with CRP, duration of the hospital stays, and mortality. 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 showed lower specificity and comparable sensitivity relative to CRP in the current study.

Research conclusions

The 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.

Research perspectives

To generalize our results, the authors need to include larger sample size and perform a multicenter study.