The Association Between D-dimer Levels and Long-Term Neurological Outcomes of Patients with Traumatic Brain Injury: An Analysis of a Nationwide Observational Neurotrauma Database in Japan

Abstract

The full-text file will be made open to the public on 30 August 2022 in accordance with publisher's 'Terms and Conditions for Self-Archiving'.; This is not the published version. Please cite only the published version. この論文は出版 社版でありません。引用の際には出版社版をご確認ご利用ください。 Title: Associations between initial serum pH value and outcomes of pediatric out-of-hospital cardiac arrest ABSTRACT Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) is one of the most critical conditions seen in the emergency department (ED). Although initial serum pH value is reported to be associated with outcome in adult OHCA patients, the association is unclear in pediatric OHCA patients. Thus, we aimed to identify the association between initial pH value and outcome among pediatric OHCA patients.Methods: This study was a retrospective analysis of a multicenter prospective cohort registry (Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry) from 87 hospitals in Japan. We included pediatric OHCA patients younger than 16 years of age who were registered in this registry between June 2014 and December 2017. Of the 34,754 patients in the database, 458 patients were ultimately included in the analysis. We equally divided the patients into four groups, based on their initial pH value, and conducted a multivariate logistic regression analysis to calculate the adjusted odds ratios of the initial pH value on hospital arrival with their 95% confidence intervals for the primary outcome. Results:The median (interquartile range) age was 1 (0-6) year, and 77.9% (357/458) of the first monitored rhythm was asystole. The primary outcome was 1-month survival. The overall 1-month survival was 13.3% (61/458), and a 1-month favorable neurologic outcome was seen in 5.2% (24/458) of cases. The adjusted odds ratios and 95% confidence intervals for the pH 6. 81-6.64, pH 6.63-6.47, pH <6.47, and pH unknown groups compared with the pH ≥6.82 group for 1-month survival were 0.

Gender-related differences in the coagulofibrinolytic responses and long-term outcomes in patients with isolated traumatic brain injury: A 2-center retrospective study

“…These findings are supported by previous studies that show that prolonged APTT and elevated D-dimer within the first hour after injury correlate with poor prognosis. [30–32]…”

“…These findings are supported by previous studies that show that prolonged APTT and elevated D-dimer within the first hour after injury correlate with poor prognosis. [30][31][32] The additional analysis suggested that differences in coagulofibrinolysis after iTBI with respect to gender occur mostly in the age group under 50 years old (Table 3). In premenopausal women, hypercoagulability occurs after trauma, and it has been shown to protect against the development of early coagulopathy after trauma.…”

Plasma D-dimer levels are a biomarker for in-hospital complications and long-term mortality in patients with traumatic brain injury

“…For changes in coagulation function in patients with TBI, D-dimer can respond quickly in the early stages, and changes can be detected in the blood within minutes after TBI ( Zhang et al, 2018 ). Prior studies have shown that D-dimer concentrations in the peripheral blood positively correlate with the risk of progressive hemorrhagic injury in patients with TBI and that D-dimer levels in patients with isolated TBI are associated with poor neurological prognosis 6 months after discharge ( Xu et al, 2020 ; Fujiwara et al, 2022 ). However, there are no existing studies on the correlation between D-dimer levels and the incidence of complications or long-term mortality during hospitalization in patients with TBI.…”

“…Among patients with TBI, those with elevated peripheral blood D-dimer levels were found to be at risk of progressive hemorrhagic injury ( Xu et al, 2020 ). Furthermore, D-dimer levels were found to predict a poor neurological prognosis 6 months after discharge in patients with isolated TBI ( Fujiwara et al, 2022 ). Additionally, measurement of the D-dimer level can reduce unnecessary CT scans for head trauma assessment in children with TBI ( Berger et al, 2015 ; Langness et al, 2018 ).…”

Regional Disparities in Hyperacute Treatment and Functional Outcomes after Acute Ischemic Stroke in Japan

“…Because the time from the onset of MT indications has changed over time, analyses were also performed for cohorts that presented within 6 h and cohorts that presented within 8 h of the onset of MT to confirm robustness. Furthermore, restricted cubic splines with three knots were employed to explore the potential nonlinear association between the RIJ as a continuous variable and a poor mRS score at discharge adjusted for the above confounders using the' rms' package in R 31) .…”