Plasma D‐dimer predicts poor outcome and mortality after spontaneous intracerebral hemorrhage

Abstract

Background The elevation of plasma D‐dimer levels may predict a higher risk of thrombosis and play a role in the pathological process of patients after spontaneous intracerebral hemorrhage (ICH). However, its function in predicting the prognosis of ICH has not been verified on large cases. Patients and Methods Retrospective cohort study of 1,332 consecutive patients with spontaneous ICH at an academic medical center was conducted. Functional outcome at three months after ICH was dichotomized using the modified Rankin Scale (0–2 versus 3–6). D‐dimer level in blood was analyzed within 1 hr of admission. An ICH outcome score combining D‐dimer level for evaluating poor functional outcome and mortality was tested. Results The proportion of patients with poor functional outcome and mortality at three months was significantly higher in patients with elevated D‐dimer level ( p < .001). Multivariable analysis demonstrated that elevated D‐dimer level was an independent predictor of poor functional outcome (odds ratio 1.486, 95% confidence interval 1.086–2.060, p = .014) and mortality (odds ratio 2.015, 95% confidence interval 1.186–3.423, p = .01). An increasing ICH outcome score combining D‐dimer level was associated with increased poor functional outcome and mortality. Conclusions Elevated plasma D‐dimer level after spontaneous ICH is associated with poor functional outcome and mortality. The study suggests that elevated D‐dimer level has a predictive value for outcome and mortality in patients with spontaneous ICH.

A Systematic Review of the Predictive Value of Plasma D-Dimer Levels for Predicting Stroke Outcome

“…After applying inclusion criteria, 19 studies remained ( Figure 1 ). Thirteen of these were retrospective cohort studies ( 25 – 28 , 30 – 35 , 44 , 45 ), while the other six were prospective cohort studies ( 29 , 46 – 50 ). Relevant data from each study was extracted and tabulated ( Table 1 ).…”

“…Thirteen studies examined the impact of D-dimer levels on poststroke functional outcome (25,26,28,31,33,35,44,49,51).…”

“…Nine studies evaluated the impact of D-dimer levels on poststroke mortality (26)(27)(28)(29)(30)(31)(32)(33)(34). A hazard ratio of 2.29 (95% CI: 1.35-3.88, p = 0.002, Figure 9) was observed, with moderate heterogeneity (I 2 : 39.03%).…”

“…To date, only a few individual retrospective cohort studies have attempted to evaluate whether plasma D-dimer levels can predict future functional outcomes and mortality post-stroke (25)(26)(27)(28). These studies have not established a consensus here.…”

“…Similarly, there is also no consensus concerning whether D-dimer levels are predictive for overall functional outcome. Some studies noted that plasma D-dimer levels were related to worse functional outcomes ( 26 , 31 , 33 , 35 ), other have reported limited correlations ( 25 , 28 ). To date, we have located one systematic review that attempted to evaluate the predictive capacity for plasma D-dimers ( 12 ).…”