The Value of Serum D-dimer in Predicting Mortality of Children with Liver Cirrhosis: A Prospective Study

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.