Plasma D-Dimer Level as Predictor of Mortality in 2-59-Month-Old Pneumonia Patients

Intravascular and intraalveolar coagulation can be found in severe pneumonia as a response to local and systemic inflammation process in severe pneumonia. Clinical consequences of this coagulation changes is an increase of plasma D-dimer levels as a marker of coagulation and fibrinolyis activation, the number of organ dysfunction even death. The aim of this study was to understand the validity of high plasma D-dimer levels as a predictor of mortality in 2 to 59-month-old pneumonia patients. This was a prospective observational analytic study which was held in Dr. Hasan Sadikin Hospital Bandung. The subjects of this study were 2 to 59 months old children who were diagnosed as pneumonia and visited Pediatric Emergency Departement during October-November 2009. Plasma D-dimer assay was performed at admission and observed until the patient died or discharged from the hospital. Forty-five children were included in this study, 15 (33%) died during observation. Plasma D-dimer level showed significant correlations (p=0.04) with the mortality in 2 to 59-month-old pneumonia patients with median and range of 0.60 mg/L (0.1-5.10 mg/L). Plasma D-dimer cut-off point of >0.4 mg/L gave 73.3% sensitivity (CI 95%, 44.9-92.0%), and 70.0% specificity (CI 95%, 50.6-85.2%) with 71.1% accuracy for predicting mortality in 2 to 59-month-old pneumonia patients. In conclusions, there were significant correlations between elevated plasma D-dimer levels and mortality in 2 to 59-month-old patients with pneumonia.