J Korean Soc Emerg Med.  2024 Aug;35(4):267-274.

Association between the D-dimer to fibrinogen ratio and neurological outcomes in patients with witnessed out-of-hospital cardiac arrest treated with targeted temperature management

• Park H
• Lim J
• Kim HJ

Abstract

Objective
During cardiac arrest and after cardiopulmonary resuscitation, a lack of pulsatile blood flow promotes rapid clot formation. After the return of spontaneous circulation, the clot burden dissipates throughout the vasculature and vital organs. Recently, the D-dimer to fibrinogen ratio (DFR) has been under consideration as a useful marker for the diagnosis and prognosis of pulmonary embolism and cardiovascular disease. This study aimed to describe the relationship between DFR and anoxic time and to evaluate the DFR and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM).
Methods
A retrospective study was performed on patients treated with TTM. Patients were divided into two groups according to their calculated DFR (DFR <4 and DFR ≥4). The primary outcome was poor neurological outcomes at six months, as defined by a Cerebral Performance Category (CPC) between 3 and 5.
Results
A total of 345 subjects were included in the study and of these, 239 subjects had poor neurological outcomes at 6 months. There was a positive correlation between DFR and the duration of cardiac arrest in 229 witnessed cardiac arrest (CA) patients (r=0.449, P<0.001). The multivariate logistic regression analysis showed that DFR ≥4 was an independent predictor for poor neurologic outcomes at 6 months after CA (odds ratio of 3.549; 95% confidence interval 1.082-11.642).
Conclusion
The D-dimer to fibrinogen ratio showed a correlation with the duration of cardiac arrest in witnessed OHCA patients and DFR ≥4 was associated with poor neurological outcomes at 6 months after CA treated with TTM.

Keyword

Out-of-hospital cardiac arrest; Targeted temperature management; Fibrinogen capsule summary