Plasma D-dimer concentration in sick newborn foals.
Authors: Armengou L, Monreal L, Tarancón I, Navarro M, Ríos J, Segura D
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Plasma D-dimer in Septic Neonatal Foals Sepsis in newborn foals triggers systemic coagulation and fibrinolytic activation, often progressing to disseminated intravascular coagulopathy (DIC), making reliable biomarkers essential for early detection and prognostication. Armengou and colleagues prospectively measured plasma d-dimer concentrations alongside coagulation parameters in 40 septic foals, 41 non-septic hospitalised foals, and 22 healthy neonates, collecting samples on admission and at 24–48 hours post-admission. Septic foals demonstrated significantly elevated d-dimer at admission (median 568 ng/mL versus 386 ng/mL in non-septic and 313 ng/mL in healthy foals), and a d-dimer threshold exceeding 2000 ng/mL at 24–48 hours showed strong association with both sepsis diagnosis (odds ratio 19.6) and death (odds ratio 8.7). Whilst d-dimer's high false-positive rate (71%) limits its value as a standalone diagnostic tool, a normal concentration effectively rules out sepsis, making it most useful for excluding rather than confirming disease. For practitioners, d-dimer measurement offers particular value in the first 48 hours of hospitalisation as part of a broader coagulation panel when sepsis is suspected, though clinical assessment and microbiological culture remain essential for definitive diagnosis and treatment decisions.
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Practical Takeaways
- •D-dimer testing at 24-48 hours post-admission with cutoff >2000 ng/mL is useful for confirming sepsis risk in sick neonatal foals, though false positives are common
- •A normal D-dimer result is more clinically useful for excluding sepsis than an elevated result is for confirming it
- •D-dimer elevation indicates coagulation system activation in septic foals but does not reliably predict DIC development, so should be interpreted alongside other hemostatic parameters
Key Findings
- •Septic foals had significantly higher median D-dimer concentration (568 ng/mL) compared to nonseptic hospitalized foals (386 ng/mL) and healthy neonates (313 ng/mL) on admission
- •D-dimer concentration >2000 ng/mL at 24-48 hours was significantly associated with septicemia diagnosis (OR=19.6) and death (OR=8.7)
- •Normal D-dimer concentration is better at ruling out sepsis than elevated D-dimer is at predicting it, due to 71% false-positive rate
- •50% of septic foals had DIC diagnosis, but D-dimer concentration was not significantly associated with DIC presence