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

  • Lee, Jung Won1
  • Her, Sun Mi2
  • Kim, Ji Hong3
  • Lee, Keum Hwa2, 4, 5
  • Eisenhut, Michael6
  • Park, Se Jin7
  • Shin, Jae Il2, 4, 5
  • 1 Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Department of Pediatrics, Seoul, South Korea , Seoul (South Korea)
  • 2 Yonsei University College of Medicine, Department of Pediatrics, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-752, South Korea , Seoul (South Korea)
  • 3 Yonsei University College of Medicine, Department of Pediatrics, Gangnam Severance Hospital, Seoul, South Korea , Seoul (South Korea)
  • 4 Severance Children’s Hospital, Department of Pediatric Nephrology, Seoul, South Korea , Seoul (South Korea)
  • 5 Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea , Seoul (South Korea)
  • 6 Luton & Dunstable University Hospital NHS Foundation Trust, Department of Pediatrics, Luton, UK , Luton (United Kingdom)
  • 7 Ajou University School of Medicine, Department of Pediatrics, Geoje Children’s Hospital, Geoje, South Korea , Geoje (South Korea)
Published Article
Pediatric Nephrology
Publication Date
Jan 06, 2018
DOI: 10.1007/s00467-017-3843-9
Springer Nature


BackgroundD-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).MethodsWe 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.ResultsThe 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.ConclusionsOur 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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