Elevated plasma D-dimer levels are associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

Abstract

Background Elevated levels of plasma D-dimer increase the risk of ischemic stroke, stroke severity, and the progression of stroke status, but the association between plasma D-dimer level and functional outcome is unclear. The aim of this study is to investigate whether plasma D-dimer level is a determinant of short-term poor functional outcome in patients with acute ischemic stroke (AIS). Methods This prospective study included 877 Chinese patients with AIS admitted to Renmin Hospital of Wuhan University within 72 h of symptom onset. Patients were categorized by plasma D-dimer level: Quartile 1(≤0.24 mg/L), Quartile 2 (0.25–0.56 mg/L), Quartile 3 (0.57–1.78 mg/L), and Quartile 4 (> 1.78 mg/L). The medical record of each patient was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale. Results Poor outcome was present in 302 (34.4%) of the 877 patients that were included in the study (mean age, 64 years; male, 68.5%). After adjustment for potential confounding variables, higher plasma D-dimer level on admission was associated with poor outcome (adjusted odds ratio 2.257, 95% confidence interval 1.349–3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor for poor outcome was a plasma D-dimer level ≥ 0.315 mg/L (area under the ROC curve 0.657; sensitivity 83.8%; specificity 41.4%). Conclusion Elevated plasma D-dimer levels on admission are significantly associated with poor outcome after admission for AIS, suggesting the potential role of plasma D-dimer level as a predictive marker for short-term poor outcome in patients with AIS.

Clinical Significance and Dynamic Change of Coagulation Parameters in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“… 13 , 21 Yao et al conducted a prospective study enrolling 877 Chinese patients with ischemic stroke and also confirmed that higher D-dimer level was related to poor clinical outcome. 8 However, this prospective study only collected admission D-dimer and the predictive value was lower compared with that of D-dimer level at 48 h in our study (AUC, 0.66 vs 0.73). There were 2 hypotheses regarding to the relationship between D-dimer and functional outcomes of ischemic stroke.…”

“… 10 In patients treated with IV tPA, coagulation parameters including fibrinogen 11 , 12 and D-dimer 13 were also reported to be related to the prognosis for ischemic stroke. However, as most studies 8 , 11 – 13 only investigated the clinical significance of one coagulation parameter at one or two time points, still much is unknown on variation trends of the coagulation parameters before and after IV tPA, and their association with prognosis of patients treated with IV tPA.…”

Brain microvascular occlusive disorder in COVID-19: a case report

“…Instead, they might reflect diffuse local thrombosis or, less likely, embolism. In this setting, high D-dimer values may reflect thrombus formation, but they can also act as acute-phase enhancer of the inflammatory cascade and stimulates monocyte synthesis and release of proinflammatory cytokines, which can contribute to the occurrence of stroke [6]. We cannot ascertain a specific correlation of the DWI findings with SARS-CoV2 infection in our patient.…”

Relationships Between D-Dimer Levels and Stroke Risk as Well as Adverse Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis

“…Finally, 22 prospective cohort studies (3,8,9,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) were included into this meta-analysis. Zakai et al reported the correlations between D-dimer levels and the risks of stroke and hemorrhagic stroke (HS); therefore, it was analyzed as two studies separately (26,27).…”