Evaluating Lactate and D-Dimer as Mortality Predictors of Paediatric Multiple Organ Dysfunction Syndrome: A Prospective Study in a Low-Middle Income Country
Authors:   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Nguyen Phuong Minh , Tran Khai Viet ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Phan Hung Viet ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Tran Khai Quang ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Tran Duc Long ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Mai Huong Thien ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Vo Thu Minh Pham ,   Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Pham Tho Kieu Anh ,   Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam, Tran Ly Cong ,   Department of Paediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
Published: August 2024

Background: Multiple Organ Dysfunction Syndrome (MODS) is a complex medical condition characterised by dysfunction across multiple organs. With limited information available on mortality prediction in the paediatric population, particularly in low-middle income countries, this study evaluates the mortality predicting capabilities of lactate, D-dimer, and their combination. Methods: This prospective study involved paediatric patients admitted to the paediatric intensive care unit (PICU) of the largest central children’s hospital in the Mekong Delta region, Vietnam, from 2019 to 2021. The discriminative ability and calibration of both individual and combined tests were assessed using the receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test. Results: Among the patients studied, 63.1% did not survive. Lactate and D-dimer concentrations were significantly higher in the non-survivor group (P < 0.001). The area under the curve (AUC) values for lactate, D-dimer and the combined lactate-D-dimer test were 0.742, 0.775 and 0.804, respectively, with the combination showing the highest AUC value, though without statistical significance. Specific thresholds for lactate, D-dimer and the combination yielded sensitivities of 75.5%, 71.7%, and 66.0%, respectively. All three tests showed no statistically significant differences between observed and predicted mortality in the Hosmer-Lemeshow test (all P-values > 0.05). Conclusion: Lactate and D-dimer levels showed a significant association with mortality, along with good discrimination and calibration abilities. These results highlight the utility of lactate and D-dimer as effective predictors in paediatric MODS, particularly in resource-limited settings, and their role in improving patient outcomes.