D-Dimer Elevation at Time of Admission is Associated with Need for Ventilator Support Among Pediatric Patients with COVID-19 Infection

Abstract

Background : One of the biggest challenges in the care of COVID-19 infected patients is predicting the severity of disease course and the need for ICU care and/or ventilator support. Published studies have suggested that D-dimer on admission can predict in-hospital mortality and prognosis. However, these data are mostly limited to adult populations with limited studies in pediatric populations. Aims : To determine if coagulation parameters at admission are associated with clinical severity of COVID-19 infection among pediatric patients. Methods : We retrospectively reviewed admission coagulation studies [Diagnostica Stago, Inc] (D-dimer, Prothrombin Time, PTTHepzyme, Fibrinogen and Platelet (PLT) count) in children with a COVID-19 diagnosis at a tertiary care pediatric hospital from April 2020 through February 2021. Disease severity was determined by ICU admission, length of stay (LOS), and need for ventilator support. Statistical analysis, including Mann Whitney U test and Pearson correlation was performed with data presented as mean ± SD with significance of P < 0.05. Results : There were 110 pediatric patients (57 females) ranging from 0.5 months to 18 years who had coagulation studies collected within 24 h of admission. Patients were divided into three groups based on ICU admission and ventilation support (see Table). Patients who required ICU admission and ventilation support had significantly higher D-dimer ( P = 0.0006) and PT ( P = 0.0083) values compared to patients who required neither. In addition, D-dimer was higher in this group when compared to those in the ICU only group ( P = 0.0099). Only D-dimer showed moderate correlation with LOS in the total cohort of patients ( r = 0.46, P < 0.0001) (Fig. 1). Conclusions : Elevated D-dimer significantly correlated with severity of disease and LOS, while elevated PT only correlated with disease severity. Our data suggest that D-dimer at admission may predict a pediatric patient's need for ICU care or ventilator support.