D-dimer has been shown as a valuable predictor for the prognosis of sepsis. But the prognostic association of an elevated D-dimer with adverse outcomes of all critical illnesses in pediatric intensive care unit (PICU) has received far less emphasis.

This was a single-center retrospective study, including 7,648 critical patients aged between 28 days and 18 years from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate.

Higher levels of D-dimer, INR, PT, APTT, and lower Fib were observed in the non-survivor group (all P < 0.001). D-dimer, INR, PT and APTT were independent risk factors for prognosis in critically ill children. There was the highest AUROC in D-dimer for predicting in-hospital mortality of critically ill patients compared with INR, PT, APTT, and Fib (D-dimer: 0.77 vs. INR: 0.73 vs. PT: 0.73 vs. APTT: 0.64 vs. Fib: 0.60). The cut-off value, sensitivity, and specificity of D-dimer were 1.53, 0.65, and 0.77, respectively. Subgroup analysis showed a stable evaluation effectiveness of D-dimer for predicting in-hospital mortality of critically ill patients in the age and gender groups.

We found poorer coagulation function in the non-survivors compared with the survivors. Among the coagulation indicators, D-dimer was most strongly associated with in-hospital mortality of unselected critically ill children.

D-二聚体已被证明是脓毒症预后的有价值的预测因子。但是，在儿科重症监护病房 (PICU) 中，升高的 D-二聚体与所有危重疾病的不良后果之间的预后关联受到的重视却少得多。

这是一项单中心回顾性研究，包括 2010 年至 2018 年儿科重症监护 (PIC) 数据库中年龄在 28 天至 18 岁之间的 7,648 名危重患者。主要结果是住院死亡率。

在非幸存者组中观察到更高水平的 D-二聚体、INR、PT、APTT 和更低的 Fib（所有磷< 0.001)。D-二聚体、INR、PT和APTT是危重患儿预后的独立危险因素。与 INR、PT、APTT 和 Fib 相比，D-二聚体在预测重症患者住院死亡率方面的 AUROC 最高（D-二聚体：0.77 对比 INR：0.73 对比 PT：0.73 对比 APTT：0.64与斐波那契：0.60）。D-二聚体的临界值、敏感性和特异性分别为1.53、0.65和0.77。亚组分析显示，D-二聚体在预测年龄和性别组危重患者住院死亡率方面具有稳定的评估效果。

我们发现与幸存者相比，非幸存者的凝血功能较差。在凝血指标中，D-二聚体与未经选择的重症儿童的住院死亡率最密切相关。