Introduction: to evaluate the prognostic value of routine coagulation parameters and D-dimer for mortality, disseminated intravascular coagulation (DIC), and multiple organ dysfunction (MODS) in pediatric septic shock in a low- and middle-income country setting. Methods: a descriptive cross-sectional study combining retrospective and prospective data was conducted in the Pediatric Intensive Care Unit of Nghe An Obstetrics and Paediatrics Hospital, Viet Nam, from September 2023 to August 2025. Children aged 1 month to 15 years with septic shock defined by Phoenix Sepsis Criteria were enrolled. Coagulation indices, including platelet count, prothrombin time (PT), international normalised ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, and D-dimer, were analysed. Receiver operating characteristic curve analysis was used to assess predictive performance for mortality, DIC, and MODS. Results: among 59 patients, overall mortality was 47.5%. Non-survivors had significantly higher disease severity, greater organ failure burden, and more pronounced coagulation abnormalities. PT and INR demonstrated strong discriminatory ability for mortality (AUC 0.899 and 0.813, respectively). Platelet count showed excellent performance for predicting DIC (AUC 0.943). PT, INR, and APTT were strong predictors of multiple organ dysfunction (AUCs >0.80), whereas D-dimer showed lower specificity across outcomes. Conclusion: routine coagulation parameters provide valuable prognostic information for mortality, DIC, and MODS in pediatric septic shock. These readily available tests complement clinical severity scores and may support early risk stratification and clinical decision-making, particularly in resource-limited settings.