Research Article: Prognostic role of early D-dimer level in patients with acute ischemic stroke

Date Published: February 1, 2019

Publisher: Public Library of Science

Author(s): Jing Zhang, Lin Liu, Jie Tao, Yanlin Song, Yimeng Fan, Maling Gou, Jianguo Xu, Bob Siegerink.

http://doi.org/10.1371/journal.pone.0211458

Abstract

The purpose of our study was to assess the prognostic role of early D-dimer level in patients with acute ischemic stroke (AIS).

The included patients’ D-dimer levels have to be tested within 24 hours from stroke onset. Poor functional outcome was defined as modified Rankin Scale (mRS) ≥3. The endpoints included recurrence on 5-day diffusion-weighted imaging, 30-day mRS ≥3, 30-day mortality and 90-day mRS ≥3. Regarding to each endpoint, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the prognostic role of D-dimer in patients with AIS.

A total of 2,479 patients were included. The results showed that elevated D-dimer levels were associated with recurrence on 5-day diffusion-weighted imaging (OR = 2.28, 95% CI = 1.32–3.95), 30-day mRS≥3 (OR = 1.59, 95% CI = 1.37–1.85), 30-day mortality (OR = 1.92, 95% CI = 1.27–2.90) and 90-day mRS≥3 (OR = 1.61, 95% CI = 1.05–2.46).

In conclusion, for patients with AIS, higher D-dimer level within 24 hours from stroke onset was associated with recurrence on 5-day diffusion-weighted imaging, mortality at 30 days, and poor functional outcome at both 30 days and 90 days. However, more studies are warranted to clarify this issue.

Partial Text

Stroke is a leading cause of disability and mortality around the world [1]. There are 2.5 million new stroke cases every year and 7.5 million stroke survivors in China [2]. Ischemic stroke, which represents around 80% of all strokes, is a result of blockade of the cerebral blood vessels [3]. The diagnosis of acute ischemic stroke (AIS) is usually based on history, physical examination and brain imaging (noncontrast CT or MRI) [4]. Thrombolysis in the therapeutic window (4.5 hours after stroke onset [5]) is beneficial for patients, however, few patients are eligible for thrombolytic therapy [6]. Many factors were found to be associated with the outcome of AIS, such as age, gender, stroke severity, atrial fibrillation, congestive heart failure, diabetes and so on [7, 8]. However, it is still difficult to predict outcome even for experienced neurologists [9]. It is useful to detect new predictors to help manage AIS [10].

The purpose of our study was to evaluate the prognostic role of early D-dimer level in patients with AIS. A meta-analysis was performed to summarize the evidence, and 9 studies were included. To our knowledge, this is the first meta-analysis in this field. Our results demonstrated that increased D-dimer level was associated with recurrence on 5-day diffusion-weighted imaging, mortality at 30 days, and poor functional outcome at both 30 days and 90 days.

 

Source:

http://doi.org/10.1371/journal.pone.0211458

 

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