High level of D‐dimer predicts ischemic stroke in patients with infective endocarditis

Abstract

Background: Ischemic stroke is one of the most prominent and serious neurological complications of infective endocarditis (IE). Our study was designed to evaluate the predictive value of higher level of plasma D-dimer on admission for the development of ischemic stroke in patients with IE. Methods:In this prospective study, a total of 173 consecutive patients with IE were recruited from January 2016 to December 2018. Plasma D-dimer and other clinical indexes of IE patients were measured after admission. The number of patients who developed ischemic stroke during 6-month follow-up was recorded, as well as the occurrence time of ischemic stroke. Results:Ischemic stroke was observed in 38 (22%) patients during 6-month follow-up since definite diagnosis of IE. Patients with ischemic stroke had significantly higher levels of plasma D-dimer than those of patients without stroke (4982 vs 2205 μg/L, P < .001). In addition, Staphylococcus aureus infection (HR: 1.96, 95% CI: 1.51-2.42), mitral valve vegetation (HR: 1.52, 95% CI: 1.32-1.75), and higher levels of on-admission plasma D-dimer (HR: 1.35, 95% CI: 1.27-1.43) were significantly associated with ischemic stroke. Moreover, D-dimer levels ≥3393 μg/L served as a strong predictor for ischemic stroke in patients with IE, and the sensitivity and specificity were 78% and 83%, respectively. Conclusion:Our study suggested that higher level of D-dimer on admission was an independent predictor for ischemic stroke in patients with IE. These patients may require special attention, in particular within the first trimester after IE diagnosis. K E Y W O R D SD-dimer, infective endocarditis, ischemic stroke | INTRODUC TI ONInfective endocarditis (IE) is a life-threatening disease, especially in developing countries such as China. The prevalence of IE ranges from 1.5 to 11.6 cases per 100 000 people around the world, 1 and IE is associated with economic and medical conditions. IE may present many extra-cardiac symptoms or signs, in which neurological complications are the most prominent and severe. 2 The manifestations of neurological complications include ischemic stroke, hemorrhagic stroke, mycotic aneurysms, brain abscesses, meningitis, and encephalitis. 3 Xu and Fu contributed equally to this work.

Clinical Significance and Prognostic Value of Hemostasis Parameters in 337 Patients with Acute Infective Endocarditis

“…Among coagulation parameters, D-dimers have received the most interest, and their use in clinical practice is well established. Our results corroborate previous data suggesting a predictive value of D-dimers for the short-term prognosis of IE and the prediction of embolism [16,17,23,24] and septic embolic stroke [18]. Consistently, Meini et al recently found that very high levels of D-dimers signaled a worse in-hospital outcome in patients with acute, severe infections [13].…”

“…Turak and colleagues suggested that high D-dimers levels on admission could identify IE patients at increased risk for in-hospital mortality [16]. Lin et al found D-dimers as a prognostic factor of in-hospital adverse events and six-month mortality [17], while Xu et al found that higher plasma D-dimers levels were predictive of ischemic stroke in 173 patients with IE [18]. However, use of coagulation markers in the prediction of IE prognosis has not yet entered into clinical practice [19].…”

Infective endocarditis complicated by embolic events: Pathogenesis and predictors

“…An elevated DD level might be a meaningful predictor for embolism as a consequence of increased fibrin turnover. In a recent study, D‐dimer levels ≥3393 μg/L were significantly associated with the incidence of ischemic stroke in patients with IE 28 …”

“… c DD > 3393 ng/dl for predicting ischemic stroke: sensitivity 78%, specificity 83%, area under the curve 0.856, 95% CI 0.77–0.92; p < .001 28 …”

Central nervous system as a target of novel coronavirus infections: Potential routes of entry and pathogenic mechanisms

“…Associated factors include co-morbidities like hypertension, diabetes or prior cerebrovascular disease (Moshayedi et al 2020). Biochemical factors like elevated C-reactive protein and elevated D-dimer also result in stroke among patients suffering from severe SARS-CoV-2 infection (Yaghi et al 2020;Tsushima et al 2020;Xu et al 2020b;Sato et al 2020;Reddy et al 2020).…”