Abstract: Objective　To explore the correlation of D-Dimer (DD), N-terminal pro-brain natriuretic peptide (NT-ProBNP), inflammatory markers such as procalcitonin (PCT), interleukin (IL-6), white blood cell count (WBC) and C-reactive protein (CRP) with the prognosis of severe pneumonia in children. Methods　A total of 107 children with severe pneumonia were divided into non-mechanical ventilation group and mechanical ventilation group according to whether they needed mechanical ventilation. Mechanical ventilation group was further divided into non-invasive ventilation group and invasive ventilation group. According to the intensive care time, the patients were divided into intensive care time ≤7 days group and intensive care time >7 days group. According to the outcome at discharge, the patients were divided into survival group and death group. The levels of DD, NTProBNP, PCT, IL-6, WBC and CRP were compared and analyzed among different groups, and the indexes were compared and evaluated by binary logistic regression analysis and receiver operating characteristic (ROC) curve. Results　The levels of DD, NTProBNP, PCT and IL-6 in mechanical ventilation group, invasive ventilation group, intensive care time >7 days group and death group were significantly higher than those in non-mechanical ventilation group, non-invasive ventilation group and intensive care time ≤7 days group and survival group (P all < 0.05), but there was no difference in WBC and CRP among those groups (P all > 0.05). Multivariate logistic regression analysis showed that DD had statistical significance in risk assessment of death in children with severe pneumonia (OR=2.72, 95%CI: 1.32~5.60, P<0.01). ROC analysis showed that the maximum area under the curve used to predict the survival of severe pneumonia in children was DD (0.89), followed by IL-6 (0.85), PCT (0.84) and NT-ProBNP (0.80). When combining DD, NT-ProBNP, PCT and IL-6, the area under the curve was 0.91, with the diagnostic sensitivity of 0.91 and the specificity of 0.85. Conclusions　DD, NT-ProBNP, PCT and IL-6 have certain clinical values in assessing the severity of severe pneumonia and its prognosis in children. The combination of four indicators can improve the predictive ability of survival. DD may be an independent biological indicator to predict the risk of death in children with severe pneumonia.