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D-dimer Level is Correlated with Prognosis, Infarct Size, and NIHSS in Acute Ischemic Stroke Patients
Nora I Abbas1, Osama Sayed1, Sherif Samir1
1Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
D-dimer levels are elevated in acute ischemic stroke patients and can predict infarct size and patient outcomes. This simple biomarker aids in assessing stroke severity and prognosis in critically ill patients.
Area of Science:
- Neurology
- Biomarkers
- Critical Care Medicine
Background:
- Stroke is a leading cause of adult mortality and disability.
- D-dimer (D-D) is a biomarker for fibrin degradation, used in venous thromboembolism diagnostics.
- The prognostic value of D-D in acute ischemic stroke (AIS) patients, particularly regarding infarct size and clinical scores, requires further investigation.
Purpose of the Study:
- To investigate the diagnostic and prognostic value of elevated plasma D-dimer in critically ill patients with acute cerebrovascular accidents.
- To explore the correlation between plasma D-D levels, ischemic lesion size on MRI, APACHE II score, and NIHSS in critically ill AIS patients.
Main Methods:
- A prospective, observational cohort study involving 30 AIS patients and 1 healthy control.
- Plasma D-D concentrations were measured using particle-enhanced immunoturbidimetric assay at admission (D0) and 24 hours later (D1).
- Demographic, clinical, laboratory, and neuroimaging data were collected and analyzed.
Main Results:
- D-dimer concentrations were significantly higher in AIS patients than in controls.
- Elevated D-D (>310 ng/mL) predicted infarct lesion size >1.5 cm on diffusion-weighted MRI with 100% sensitivity and 83% specificity.
- D-D levels at D0 (>350 ng/mL) and D1 (>370 ng/mL) predicted a complicated course with 100% sensitivity and 84.6% specificity.
Conclusions:
- Plasma D-dimer is a readily available biomarker for predicting infarct size in diffusion-weighted MRI.
- D-dimer levels correlate with prognosis and can aid in assessing outcomes for acute ischemic stroke patients.
- D-dimer testing can be integrated with standard clinical assessments for improved stroke management.
Abstract:
Stroke ranks the fourth leading disease causing adult mortality and disability. D-dimer (D-D) is the ultimate product of plasmin-mediated degradation of fibrin-rich thrombi. D-D is a simple readily accessible biomarker employed within the diagnostic algorithms for the exclusion of venous thromboembolism. The correlation between D-D infarct size in MRI brain, APACHE II score, and the National Institute of Health Stroke Scale (NIHSS) score in critically ill acute stroke patients has not been fully investigated before.
Objective:
We aimed to investigate the diagnostic and prognostic value of elevated plasma D-D in critically ill patients admitted with acute cerebrovascular accidents. As far as we know, we are the first to investigate the correlation between plasma D-D levels and the ischemic lesion size in MRI brain and also APACHE II score and NIHSS in critically ill acute ischemic cerebrovascular patients.
Setting And Participants:
A prospective, observational cohort study inside the Critical Care Medicine Department. Thirty patients with AIS were enrolled additionally to 1 healthy age- and sex-matched controls.
Interventions:
We employed particle-enhanced, immunoturbidimetric assay to detect plasma D-D concentrations. D-D levels D0 and D1 were measured upon admission and 24 hours later, respectively. We reviewed the patient' s health records; additionally, demographic, clinical, laboratory, and neuroimaging information was abstracted.
Results:
D-D concentrations were significantly higher in acute stroke patients compared to healthy controls. ROC curve analysis showed that elevated D-D level more than 310 ng/mL can predict infarct lesion size >1.5 cm in diffusion-weighted MRI brain with sensitivity and specificity (100 and 83%, respectively) and also admission D-D (D0) at cutoff concentration 350 ng/mL and D1 at cutoff value 370 ng/mL are predictors of complicated course with sensitivity and specificity (100 and 84.6%, respectively). There was no significant difference between D0 and D1 D-D levels (p-value >0.05).
Conclusion:
The plasma D-D biomarker can be a simple readily available test reliable predictor of infarct lesion size >1.5 cm in DW-MRI and outcome in union with the common practice instrumental tests.
How To Cite This Article:
Abbas NI, Sayed O, Samir S, Abeed N. D-dimer Level is Correlated with Prognosis, Infarct Size, and NIHSS in Acute Ischemic Stroke Patients. Indian J Crit Care Med 2021;25(2):193-198.
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