Low D-dimer levels in sepsis: Good or bad?

•DIC is a serious complication of sepsis and increases the risk of death. •D-dimer (DD) is the most used fibrin-related marker for DIC diagnosis. •However, DD levels depend on both coagulation and fibrinolysis. •Patients with severe sepsis and normal DD were shown to have the highest mortality. •Allegedly, normal DD in sepsis masks a DIC form with strong fibrinolysis inhibition.