J Neurocrit Care.  2017 Jun;10(1):19-27. 10.18700/jnc.160084.

D-dimer Predicts Short-Term Functional Outcome in Acute Ischemic Stroke

Affiliations
  • 1Department of Neurology, Kosin University College of Medicine, Busan, Korea. ybg99@naver.com

Abstract

BACKGROUND
The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome.
METHODS
Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS).
RESULTS
Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P<0.05). After the adjustment of National Institutes of Health Stroke Scale (NIHSS) scores on admission, the plasma D-dimer levels positively correlated with mRS (Spearman partial rho=0.247, P<0.001). The cut-off value of D-dimer level for prediction of poor outcomes was 0.35 mg/L (sensitivity 0.70, specificity 0.63, area under the curve 0.71). Furthermore, two multivariated logistic regression analysis models were performed. One model excluded the NIHSS score as an independent variable, and demonstrated that D-dimer (odds ratio, 1.24 for every 1.0 mg/L, P<0.05) was independently associated with poor functional outcome. Conversely, the other model which included the NIHSS score, did not show any such association.
CONCLUSIONS
Plasma D-dimer level is a useful marker for short-term outcomes in acute ischemic stroke, and may have a role in risk stratification for predicting a poor outcome.

Keyword

Cerebral Infarction; D-dimer; Prognosis

MeSH Terms

Atrial Fibrillation
C-Reactive Protein
Cerebral Cortex
Cerebral Infarction
Fasting
Female
Humans
Hypertension
Incidence
Logistic Models
Male
National Institutes of Health (U.S.)
Plasma
Prognosis
Sensitivity and Specificity
Stroke*
C-Reactive Protein

Figure

  • Figure 1. Difference of plasma D-dimer levels according to stroke etiology. Plasma D-dimer levels were not significantly different according to stroke etiology defined by TOAST classifications (P=0.128, analysis of variance). TOAST, tial of org 10172 in acute stroke treatment; LAA, large-artery atherosclerosis; SVO, small-vessel occlusion; CE, cardioembolism; OD, other determined; UD, undetermined.

  • Figure 2. Correlation between plasma D-dimer levels and NIHSS on admisson (A) and mRS (B) on 3 months. NIHSS on admisson (A) and mRS (B) on 3 months were significantly correlated with plasma D-dimer levels. NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale.

  • Figure 3. ROC curve. The cut-off value of serum D-dimer level for prediction of the poor outcome was 0.35 µg/ml (sensitivity 0.70, specificity 0.63, AUC 0.71). ROC, receiver operating characteristic; AVC, area under the curve.


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