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

Jung Won Lee, Sun Mi Her, Ji Hong Kim, Keum Hwa Lee, Michael Eisenhut, Se Jin Park, Jae Il Shin

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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.

Original languageEnglish
Pages (from-to)631-637
Number of pages7
JournalPediatric Nephrology
Volume33
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

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All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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