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D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection

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Abstract

Background

D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI).

Methods

We retrospectively analyzed the data of 177 young infants (<2 years) with febrile UTI between 2005 and 2014, grouped as APN and lower UTI groups. Conventional inflammatory markers (white blood cell count (WBC), erythrocyte sedimentation rates (ESR), C-reactive protein (CRP)), and D-dimer were measured.

Results

The WBC counts (P = 0.002), ESR (P < 0.0001), CRP (P < 0.0001), D-dimer levels (P = 0.006) and the presence of VUR (P < 0.0001) were significantly higher in the APN group than in the lower UTI group. Multiple logistic regression analyses showed that D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001–1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499–0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN.

Conclusions

Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.

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Authors and Affiliations

  1. Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea

    Jung Won Lee

  2. Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea

    Sun Mi Her, Keum Hwa Lee & Jae Il Shin

  3. Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Ji Hong Kim

  4. Department of Pediatric Nephrology, Severance Children’s Hospital, Seoul, South Korea

    Keum Hwa Lee & Jae Il Shin

  5. Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea

    Keum Hwa Lee & Jae Il Shin

  6. Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK

    Michael Eisenhut

  7. Department of Pediatrics, Geoje Children’s Hospital, Ajou University School of Medicine, Geoje, South Korea

    Se Jin Park

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  1. Jung Won Lee
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Correspondence to Jae Il Shin.

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Approval and consent

The Institutional Review Board and Research Ethics Committee of Yonsei University Severance Hospital approved this study. We were given exemption from getting informed consent by the IRB because the present study is a retrospective study and personal identifiers were completely removed and the data analyzed anonymously. Our study was conducted according to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Lee, J.W., Her, S.M., Kim, J.H. et al. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol 33, 631–637 (2018). https://doi.org/10.1007/s00467-017-3843-9

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  • DOI: https://doi.org/10.1007/s00467-017-3843-9

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