The Prognostic Value of Serum D-Dimer in Acute Ischemic Stroke Patients Prospective Cohort Study

International Journal of Medical Science

© 2022 by SSRG - IJMS Journal

Volume 9 Issue 6

Year of Publication : 2022

Authors : Abdulhamed Ismaiel, Eisa Layka, Faisal Redwan

10.14445/23939117/IJMS-V9I6P102

How to Cite?

Abdulhamed Ismaiel, Eisa Layka, Faisal Redwan, "The Prognostic Value of Serum D-Dimer in Acute Ischemic Stroke Patients Prospective Cohort Study," SSRG International Journal of Medical Science, vol. 9,  no. 6, pp. 11-17, 2022. Crossref, https://doi.org/10.14445/23939117/IJMS-V9I6P102

Abstract:

Acute ischemic stroke (AIS) is considered one of the major causes of death and long-term functional disability. This study aims to evaluate the predictive role of serum D-dimer upon admission. Results: This prospective cohort study included (n=191) patients with AIS admitted to the hospital within 48 hours from the onset of symptoms. Serum D-dimer levels were measured upon admission, stroke severity was determined by (NIHSS), and functional outcomes were assessed on the modified Rankin scale (mRs) after 30 days. Higher levels of serum D-dimer were associated with more severe strokes (OR = 1.5, 95% CI = 1.1–2.4). High serum D-dimer levels were an independent risk factor for predicting a bad prognosis (OR = 19.3, 95% CI = 5.9–62.7). The cut-off point for a bad prognosis was D-dimer =0.79 mg/L with a sensitivity of 92.6% and 88% specificity. The mortality rate among patients was about 8.4% (16 patients) after a 30-day follow-up. Patients who died recorded higher values of serum D-dimer. Conclusion: Elevated serum D-dimer levels on admission in patients with AIS were associated with higher stroke severity, bad prognosis, and high mortality rate at 30 days.

Keywords:

Acute ischemic stroke, D-dimer, Prognosis.

References:

[1] Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA and Hennerici MG, “Classification of stroke subtypes,” Cerebrovasc Dis, vol. 27, no. 5, pp. 493-501, 2009. Crossref, https://doi.org/10.1159/000210432
[2] Haapaniemi E and Tatlisumak T. Is D-dimer helpful in evaluating stroke patients? A systematic review. Acta Neurol Scand, vol. 119, no. 3, pp. 141-150, 2009. Crossref, https://doi.org/10.1111/j.1600-0404.2008.01081.x
[3] Sealy-Jefferson S, Wing JJ, Sánchez BN, et al. “Age- and Ethnic-Specific Sex Differences in Stroke Risk,” Gend med, vol. 9, no. 2, pp. 121-128, 2012. Crossref, https://doi.org/10.1016/j.genm.2012.02.002
[4] Brown RD, Whisnant JP, Sicks JD, O'Fallon WM and Wiebers DO, “Stroke Incidence, Prevalence, and Survival: Secular Trends in Rochester, Minnesota, Through 1989,” Stroke, vol. 27, no. 3, pp.373-380, 1996.
[5] Wolf PA, D'Agostino RB, O'Neal MA, et al, “Secular Trends In Stroke Incidence And Mortality,” Stroke, vol. 23, no. 11, pp. 1551- 1555, 1992. Crossref, https://doi.org/10.1161/01.STR.23.11.1551
[6] Di Castelnuovo A, Agnoli C, de Curtis A, et al, “Elevated Levels of D-Dimers Increase the Risk of Ischaemic and Haemorrhagic Stroke,” Thromb Haemost, vol. 112, no. 5, pp. 941-946, 2014. Crossref, https://doi.org/10.1160/TH14-04-0297
[7] Hamatani Y, Nagai T, Nakai M, Nishimura K, Honda Y, Nakano H et al, “Elevated Plasma D-Dimer Level is Associated with ShortTerm Risk of Ischemic Stroke in Patients with Acute Heart Failure,” Stroke, vol. 49, no. 7, pp. 1737–1740, 2018. Crossref, https://doi.org/10.1161/STROKEAHA.118.021899
[8] Barbieri A, Giuliani E, Carone C, et al, “Clinical Severity Of Ischemic Stroke And Neural Damage Biomarkers In The Acute Setting the STROke MArkers (STROMA) study,” Minerva Anestesiol, vol. 79, no. 7, pp. 750-757, 2013.
[9] Yang XY, Gao S, Ding J, Chen Y, et al, “Plasma D-Dimer Predicts Short-Term Poor Outcome After Acute Ischemic Stroke,” PLoS One, vol. 9, no. 2, pp. e89756, 2014. Crossref, https://doi.org/10.1371/journal.pone.0089756
[10] Kim TW, Song IU, Chung SW, “Prognostic Value of Serum D-Dimer in Noncardioembolic Ischemic Stroke,” Canadian Journal of Neurological Sciences, vol. 44, no. 4, pp. 404-409, 2017. Crossref, https://doi.org/10.1017/cjn.2016.299
[11] Zhang J, Liu L, Tao J, et al, “Prognostic Role of Early D-Dimer Level in Patients with Acute Ischemic Stroke,” PLoS One, vol. 14, no. 2, pp. e0211458, 2019. Crossref, https://doi.org/10.1371/journal.pone.0211458
[12] Squizzato A, Ageno W, Finazzi S, et al, “D-Dimer is Not a Long-Term Prognostic Marker Following Acute Cerebral Ischemia,” Blood Coagul Fibrinolysis, vol. 17, no. 4, pp. 303-306, 2006.
[13] Rallidis LS, Vikelis M, Panagiotakos DB, Liakos GK, et al, “Usefulness of Inflammatory and Haemostatic Markers to Predict Short-Term Risk for Death in Middle-Aged Ischaemic Stroke Patients,” Acta Neurol Scand, vol. 117, no. 6, pp.415-420, 2008. Crossref, https://doi.org/10.1111/j.1600-0404.2007.00971.x
[14] Ageno W, Finazzi S, Steidl L, et al, “Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes,” Arch Intern Med, vol. 162, no. 22, pp. 2589-2593, 2002. Crossref, https://doi.org/10.1001/archinte.162.22.2589
[15] Liu LB, Li M, Zhuo WY, Zhang YS and Xu AD, “The Role of hs-CRP, D-Dimer And Fibrinogen in Differentiating Etiological Subtypes of Ischemic Stroke,” PLoS One, vol. 10, no. 2, pp. e0118301, 2015.
[16] Montaner J, Perea-Gainza M, Delgado P, et al, “Etiologic Diagnosis of Ischemic Stroke Subtypes with Plasma Biomarkers,” Stroke, vol. 39, no. 8, pp. 2280-2287, 2008. Crossref, https://doi.org/10.1161/STROKEAHA.107.505354
[17] Fisher M and Francis R, “Altered coagulation in cerebral ischemia. Platelet, thrombin, and plasmin activity,” Arch Neurol, vol. 47, no. 10, pp. 1075-1079, 1990. Crossref, https://doi.org/10.1001/archneur.1990.00530100037011
[18] Nezu T, Kitano T, Kubo S, Uemura J, et al, “Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients,” Journal of Neurology, vol. 265, no. 3, pp. 628–636, 2018. Crossref, https://doi.org/10.1007/s00415-018-8742-x 
[19] Kono T, Ohtsuki T, Hosomi N, Takeda I, et al, “Cancer-Associated Ischemic Stroke is Associated with Elevated d-Dimer and Fibrin Degradation Product Levels in Acute Ischemic Stroke with Advanced Cancer,” Geriatrics & Gerontology International, vol. 12. No. 5, pp. 468-474, 2012. Crossref, https://doi.org/10.1111/j.1447-0594.2011.00796.x
[20] Matsuo T, Kobayashi H, Kario K and Suzuki S, “Fibrin D-Dimer in Thrombogenic Disorders,” Semin Thromb Hemost, vol. 26, no. 1, pp. 101-107, 2000. Crossref, https://doi.org/10.1055/s-2000-9811
[21] Kogan AE, Mukharyamova KS, Bereznikova AV, et al, “Monoclonal Antibodies with Equal Specificity to D-Dimer and HighMolecular-Weight Fibrin Degradation Products,” Blood Coagul Fibrinolysis, vol. 27, no. 5, pp. 542-550, 2016. Crossref, https://doi.org/10.1097/MBC.0000000000000453
[22] Salvagno GL, Lippi G, Montagnana M, Franchini M, et al, “Influence of Temperature and Time Before Centrifugation of Specimens for Routine Coagulation Testing,” International Journal of Hematology, vol. 31, no. 4, pp. 462-467, 2009. Crossref, https://doi.org/10.1111/j.1751-553X.2008.01058.x
[23] Lip GY, Blann AD, Farooqi IS, Zarifis J, et al, “Sequential Alterations in Haemorheology, Endothelial Dysfunction, Platelet Activation and Thrombogenesis in Relation to Prognosis Following Acute Stroke: the West Birmingham Stroke Project,” Blood Coagul Fibrinolysis, vol. 13, no. 4, pp. 339-347, 2002. Crossref, https://doi.org/10.1097/00001721-200206000-00010
[24] oulon P, Metge S, Hangard M, Zwahlen S, Piaulenne S and Besson V, “Impact of Different Storage Times at Room Temperature of Unspun Citrated Blood Samples on Routine Coagulation Tests Results. Results of a Bicenter Study and Review of the Literature,” International Journal of Hematology, vol. 39, no. 5, pp. 458-468, 2017. Crossref, https://doi.org/10.1111/ijlh.12660
[25] Robson SC, Shephard EG and Kirsch RE, “Fibrin Degradation Product D-Dimer Induces The Synthesis And Release Of Biologically Active IL-1 Beta, IL-6 and Plasminogen Activator Inhibitors from Monocytes in Vitro,” British Journal of Haematology, vol. 86, no. 2, pp. 322-326, 1994. Crossref, https://doi.org/10.1111/j.1365-2141.1994.tb04733.x
[26] Castellanos M, Castillo J, García MM, et al, “Inflammation-Mediated Damage in Progressing Lacunar Infarctions,” Stroke, vol. 33, no. 4, pp. 982-987, 2002. Crossref, https://doi.org/10.1161/hs0402.105339