Plasma D-Dimer Predicts Short-Term Poor Outcome after Acute Ischemic Stroke

Abstract

ObjectiveHaemostatic biomarkers associated with poor outcome in acute ischemic stroke (AIS). The objective of the study was to evaluate the predictive value of plasma D-dimer (D-D) on functional outcome at 90-day follow-up from stroke onset.MethodsWe conducted a prospective, observational cohort study in the emergency department and enrolled 220 patients with AIS. Plasma D-D concentrations, determined by a particle-enhanced, immunoturbidimetric assay, were measured. Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted.ResultsThere was a positive correlation between levels of D-D and the NIHSS (r = 0.361, p<0.001), and the infarct volume (r = 0.449, p<0.001). In the 69 patients with an unfavorable functional outcome, D-D levels were higher compared with those in patients with a favorable outcome [3.24(IQR, 2.18–4.60)mg/L vs 0.88(IQR, 0.35–1.77) mg/L; p<0.001]. After adjusting for all other significant outcome predictors, D-D level remained an independent predictor for unfavorable functional outcome and mortality with an odds ratio of 2.18 (95% CI, 1.55–2.83), 3.22 (95% CI, 2.05–6.43); respectively.ConclusionsD-D levels are a useful tool to predict outcome and mortality 90-day after acute ischemic stroke and have a potential to assist clinicians.

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

“…The result of the present study showed a significant correlation between the D-dimer levels and the size of the cerebral infarction which agreed with Yang et al [25] who found that there was a positive correlation between levels of D-dimer and the infarct volume. For fibrinogen and CRP, the results of the present study showed a significant correlation between both biomarkers and size of the infarction which coincided with agreement with Yigun and Bakirci [26] who found that patients with large infarcts in the median cerebral artery and anterior cerebral artery had higher fibrinogen and CRP concentrations than the control group.…”

“…The present study showed that D-dimer, fibrinogen and CRP had significant relation with poor outcome at 30 days which agreed with Yang et al [25] who found that elevated levels of D-dimer were short-term prognostic marker of outcome and death in patients with acute ischemic stroke, also it agreed with De Zoppo et al [29] who found that the proportion of patients with good functional outcome decreased with increasing initial fibrinogen levels and patients with initial fibrinogen levels < 450 mg/dL had better outcomes. In agreement with our study, Hamidon et al [30] found that elevated CRP level in acute ischemic stroke was a predictor of severe functional disability at 1 month and was also associated with larger infarcts.…”

Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

“…Especially D-dimer was effective in identifying IS etiology [181,182] and showed good prognostic accuracy as predictor of short- and long-term worse outcome [182,183,185,186]. Similar results were also reported for E-selectin and VCAM-1, but those data required further validation in additional large-cohort studies [184].…”

“…Furthermore, specific challenges regarding biomarkers of central nervous tissue include the penetration of BBB and the lack of correlation between functional symptoms and volume (as opposed to location) of injured tissue. According to pathophysiological processes underlying IS, potential inflammatory biomarkers may be classified as released by: (i) astroglial activation and neuronal injury (Table 1) [146,147,148,149,150,151,152,153,154,155,156,157]; (ii) systemic inflammatory response (Table 2) [158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179]; (iii) dysfunctional endothelium (Table 3) [180,181,182,183,184,185,186] (Figure 4). …”

High Plasma D-Dimer Indicates Unfavorable Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis

“…One in vivo study suggested that the presence of D-dimer reflects thromboembolic activity [5] , and several clinical studies have shown the association between D-dimer level with post-stroke outcome [6][7][8][9] . Besides, Welsh et al [9] investigated as much as 16 kinds of hemostatic or inflammatory biomarkers in patients with AIS; only D-dimer and CRP are independently associated with unfavorable 30 days outcome.…”