Dae Seung Lee and Jin-Hyung Lee
Kosin University College of Medicine, Korea
Posters & Accepted Abstracts: J Neurol Neurophysiol
Background: Increased plasma D-dimer levels have been correlated with adverse outcomes in various clinical conditions. The prognostic value of D-dimer in acute ischemic stroke is limited and remains controversial. The objective of the study was to evaluate the predictive value of plasma D-dimer at admission on short-term functional outcome after acute ischemic stroke. Methods: We measured fasting plasma D-dimer in consecutive 290 patients (61.7% men, mean age 67.0�±12.3 years) within 3 days after the onset of acute ischemic stroke. Plasma D-dimer levels were detected within 24 hours of admission. Outcomes were measured by the modified Rankin Scale (mRS) at 3-months after stroke onset. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Results: The frequency of woman, atrial fibrillation, hypertension, diabetes and involvement of insular cortex, age, and the level of plasma high sensitive C-reactive protein (hs-CRP) and D-dimer were each significantly higher in the poor outcome group (p<0.05). The level of albumin, heart rate and the estimated glomerular filtration rate in the poor outcome group were significantly lower than that in the good outcome group (p<0.05). In age- and plasma creatinine-adjusted analysis, plasma D-dimer levels were positively correlated with NIHSS scores (partial r=0.181, p<0.01) and mRS (partial r=0.257, p<0.001). The cut-off value of D-dimer level for prediction of the poor outcome was 0.35 �¼g/ml (sensitivity 0.70, specificity 0.63, AUC 0.71). Multivariate logistic regression analysis demonstrated that age (OR, 1.11 for every 1 year; 95% CI, 1.05- 1.16, p<0.001), the presence of DM (OR, 2.51; 95% CI, 1.11-5.66, p<0.05), hs-CRP (OR, 1.16 for every 1.0 mg/dl; 95% CI, 1.01- 1.34,p<0.05), D-dimer (OR, 1.24 for every 1.0 �¼g/ml; 95% CI, 1.04-1.49, p<0.05), and the involvement of the insular cortex (OR, 3.16; 95% CI, 1.22-8.16, p<0.05) were independently associated with poor functional outcome. Conclusions: Plasma D-dimer is a useful marker for short-term outcome in acute ischemic stroke. D-dimer may have a role in risk stratification for predicting poor outcome.
Email: dae002@nate.com
