Diagnostic value of D-dimer in differentiating multisystem inflammatory syndrome in Children (MIS-C) from Kawasaki disease: systematic literature review and meta-analysis

Giuseppe Lippi; Camilla Mattiuzzi; Emmanuel J. Favaloro

doi:10.1515/dx-2024-0013

Article

Diagnostic value of D-dimer in differentiating multisystem inflammatory syndrome in Children (MIS-C) from Kawasaki disease: systematic literature review and meta-analysis

Giuseppe Lippi , Camilla Mattiuzzi and Emmanuel J. Favaloro

Published/Copyright: February 21, 2024

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From the journal Diagnosis Volume 11 Issue 3

Abstract

Coronavirus disease 2019 (COVID-19) is frequently associated with thrombo inflammation, which can predispose to developing of life-threatening conditions in children such as the multisystem inflammatory syndrome (MIS-C) and Kawasaki disease. Because of the consistent overlap in pathogenesis and symptoms, identifying laboratory tests that may aid in the differential diagnosis of these pathologies becomes crucial. We performed an electronic search in PubMed, Web of Science and Scopus, without date or language restrictions, to identify all possible studies reporting D-dimer values in separate cohorts of children with MIS-C or Kawasaki disease. Three multicenter cohort studies were included in our analysis, totaling 487 patients (270 with MIS-C and 217 with Kawasaki disease). In this meta-analysis, significantly higher D-dimer values were found in MIS-C compared to Kawasaki disease in all three studies, yielding an SMD of 1.5 (95 % CI, 1.3–1.7) mg/L. Thus, very high D-dimer values early in the course of disease should raise the clinical suspicion of MIS-C rather than Kawasaki disease. Further studies should be planned to identify harmonized D-dimer diagnostic thresholds that may help discriminate these conditions.

Keywords: coronavirus; COVID-19; multisystem inflammatory syndrome in children; Kawasaki disease; D-dimer

Corresponding Author: Prof. Giuseppe Lippi, MD, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, Verona 37134, Italy, Phone: +39 045 8124308, Fax: +39 045 8122970, E-mail: giuseppe.lippi@univr.it

Research ethics: The study was conducted in accordance with the Declaration of Helsinki and in compliance with relevant local legislation.
Informed consent: Not applicable.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Data will be available upon reasonable request to the corresponding author.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2024-0013).

Received: 2024-01-16

Accepted: 2024-02-07

Published Online: 2024-02-21

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Supplementary Material

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Keywords for this article

coronavirus; COVID-19; multisystem inflammatory syndrome in children; Kawasaki disease; D-dimer