Document Type : original article
1 MD, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 1. MD, MPH, Professor of Pediatrics Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 MD, Fellowship of pediatric gastroenterology and hepatology, Department of pediatric gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
Background: Liver cirrhosis is one of the major causes of mortality worldwide. Finding new methods to stratify patients with liver cirrhosis can affect the treatment plan and improve the outcomes. The present study aimed to determine the prognostic value of the serum D-dimer level in pediatric patients with liver cirrhosis.
Method: All cirrhotic pediatric patients admitted to Namazi Hospital (Shiraz, Iran) between November 2020 and November 2021 underwent serum D-dimer level testing on admission and were prospectively analyzed for 90 days. The Mann-Whitney U test was used to evaluate the correlation between D-dimer level and patient mortality. In addition, ROC (Receiver Operating Curve) analysis was used to evaluate the specificity and sensitivity of the D-dimer level in predicting mortality.
Result: In total, 38 patients with cirrhosis were included in this study. The serum D-dimer level was significantly correlated with the mortality of children with liver cirrhosis (P = 0.01), and the area under the ROC of the serum D-dimer level for this prediction was 0.777 (P = 0.01). The best cut-off D-dimer value was 1641.5 ng/ml, which offered a sensitivity of 70.0% and specificity of 82.14% for predicting mortality. We detected no significant correlation between the D-dimer level and the PELD (Pediatric End-stage Liver Disease) or MELD (Model for End-stage Liver Disease) score.
Conclusion: The D-dimer level is significantly associated with the mortality of children with cirrhosis. Therefore, D-dimer testing can be used as a stratification marker to prioritize patients waiting on the liver transplant list
- Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJL, Naghavi M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014; 12:145.
- Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. J Am Coll Cardiol. 2017; 70(19):2411-20.
- Le Gal G, Righini M, Wells PS. D-dimer for pulmonary embolism. Jama. 2015; 313(16):1668-9.
- Qi T, Zhu C, Lu G, Hao J, He Q, Chen Y, Zhou F, Chen J, Hou J. Elevated D-dimer is associated with increased 28-day mortality in acute-on-chronic liver failure in China: a retrospective study. BMC Gastroenterol. 2019; 19(1):20.
- Mikuła T, Sapuła M, Jabłońska J, Kozłowska J, Stańczak W, Krankowska D, Stańczak W, Krankowska D, Wiercińska-Drapało A. Significance of Heparin-Binding Protein and D-dimers in the Early Diagnosis of Spontaneous Bacterial Peritonitis. Mediators Inflamm. 2018; 2018:1969108.
- Spadaro A, Tortorella V, Morace C, Fortiguerra A, Composto P, Bonfiglio C, Alibrandi A, Luigiano C, Caro GD, Ajello A, Ferrau O, Freni MA. High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis. World J Gastroenterol. 2008; 14(10):1549-52.
- Saray A, Mesihovic R, Gornjakovic S, Vanis N, Mehmedovic A, Nahodovic K, Glavas S, Papovic V. Association between high D-dimer plasma levels and ascites in patients with liver cirrhosis. Med Arch. 2012; 66(6):372-4.
- Dai J, Qi X, Li H, Guo X. Role of D-dimer in the Development of Portal Vein Thrombosis in Liver Cirrhosis: A Meta-analysis. Saudi J Gastroenterol. 2015; 21(3):165-74.
- Li Y, Qi X, Li H, Dai J, Deng H, Li J, Peng Y, Liu X, Sun X, Guo X. D-dimer level for predicting the in-hospital mortality in liver cirrhosis: A retrospective study. Exp Ther Med. 2017; 13(1):285-9.
- Gürsoy S, Başkol M, Torun E, Yurci A, Soyuer I, Eser B, Güven K, Ozbakir O, Yücesoy M. Importance of anticoagulant proteins in chronic liver diseases. Turk J Gastroenterol. 2005; 16(3):129-33.
- El-Sayed R, El-Karaksy H, El-Raziky M, El-Hawary M, El Koofy N, Helmy H, Fahmy M. Assessment of coagulation and fibrinolysis in children with chronic liver disease. Blood Coagul Fibrinolysis. 2013; 24(2):113-7.
- Leung DH, Narang A, Minard CG, Hiremath G, Goss JA, Shepherd R. A 10-Year united network for organ sharing review of mortality and risk factors in young children awaiting liver transplantation. Liver Transpl. 2016; 22(11):1584-92.
- Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, Wainright J L, Snyder J J, Israni A K, Kasiske B L. OPTN/SRTR 2016 Annual Data Report: Liver. Am J Transplant. 2018; 18 Suppl 1:172-253.
- Swenson SM, Roberts JP, Rhee S, Perito ER. Impact of the Pediatric End-Stage Liver Disease (PELD) growth failure thresholds on mortality among pediatric liver transplant candidates. Am J Transplant. 2019; 19(12):3308-18.