D-Dimer Elevation at Time of Admission is Associated with Need for Ventilator Support Among Pediatric Patients with COVID-19 Infection

Objectives: One of the biggest challenges in the care of COVID-19 infected patients is predicting the severity of disease course and the need for ICU care and/or ventilator support. This study aims to determine if coagulation parameters at admission are associated with clinical severity of COVID-19 infection among pediatric patients. Design: Retrospective chart review.Setting: Tertiary children’s hospital in Houston, TX.Patients: Children with positive SARS-CoV-2 test requiring admission from April 1, 2020 to February 28, 2021.Interventions: Observational study. Measurements and Main Results: We retrospectively reviewed admission coagulation studies (D-dimer, Prothrombin Time, PTT-Hepzyme, Fibrinogen and Platelet count) in children with a COVID-19 diagnosis. Disease severity was determined by ICU admission, length of stay (LOS), and need for ventilator support. There were 110 pediatric patients (57 females) ranging from 0.5 months to 18 years who had coagulation studies collected within 24 hours of admission. Patients were divided into three groups based on ICU admission and ventilation support. Patients who required ICU admission and ventilation support had significantly higher D-dimer and PT values compared to patients who required neither. In addition, D-dimer was higher in this group when compared to those in the ICU only group. Only D-dimer showed moderate correlation with LOS in the total cohort of patients. Conclusions: Elevated D-dimer significantly correlated with severity of disease and LOS, while elevated PT only correlated with disease severity. Our data suggest that D-dimer at admission may predict a pediatric patient’s need for ICU care or ventilator support.