Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea.
Pediatr Nephrol. 2018 Apr;33(4):631-637. doi: 10.1007/s00467-017-3843-9. Epub 2018 Jan 6.
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).
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.
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.
Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.
在严重细菌感染和脓毒症期间，D-二聚体以及其他与凝血相关的生物标志物显著增加。本研究旨在评估血清 D-二聚体作为生物标志物在诊断急性肾盂肾炎（APN）和预测尿路感染（UTI）婴儿中输尿管反流（VUR）的有用性。
我们回顾性分析了 2005 年至 2014 年间 177 名患有发热性 UTI 的年轻婴儿（<2 岁）的数据，将其分为 APN 和下尿路感染组。测量了常规炎症标志物（白细胞计数（WBC）、红细胞沉降率（ESR）、C 反应蛋白（CRP））和 D-二聚体。
APN 组的 WBC 计数（P=0.002）、ESR（P<0.0001）、CRP（P<0.0001）、D-二聚体水平（P=0.006）和 VUR 的存在（P<0.0001）均明显高于下尿路感染组。多变量逻辑回归分析显示，D-二聚体（比值比[OR]：1.003，95%可信区间：1.001-1.006，P=0.002）是 UTI 儿童 VUR 的独立预测因子。D-二聚体（曲线下面积[AUC]值为 0.621，P=0.046，95%可信区间：0.499-0.743）的 ROC 曲线预测 VUR 的 AUC 值高于其他炎症标志物，但预测 APN 时不如 CRP。
我们的结果表明，D-二聚体除其他炎症标志物外，还可作为发热性 UTI 婴儿的炎症标志物。
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