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Baek JH, Heo JH, Nam HS, Kim BM, Kim DJ, Kim YD. Preprocedural D-Dimer Level as a Predictor of First-Pass Recanalization and Functional Outcome in Endovascular Treatment of Acute Ischemic Stroke. J Clin Med 2023; 12:6289. [PMID: 37834933 PMCID: PMC10573512 DOI: 10.3390/jcm12196289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
We aimed to evaluate the association between preprocedural D-dimer levels and endovascular and clinical outcomes. We retrospectively reviewed patients with acute intracranial large-vessel occlusion who underwent mechanical thrombectomy. Plasma D-dimer levels were measured immediately before the endovascular procedure. Endovascular outcomes included successful recanalization, first-pass recanalization (first-pass effect (FPE) and modified FPE (mFPE)), thrombus fragmentation, and the number of passes of the thrombectomy device. Clinical outcomes were assessed at 3 months using the modified Rankin Scale. A total of 215 patients were included. Preprocedural D-dimer levels were lower in patients with FPE (606.0 ng/mL [interquartile range, 268.0-1062.0]) than in those without (879.0 ng/mL [437.0-2748.0]; p = 0.002). Preprocedural D-dimer level was the only factor affecting FPE (odds ratio, 0.92 [95% confidence interval, 0.85-0.98] per 500 ng/mL; p = 0.022). D-dimer levels did not differ significantly based on successful recanalization and thrombus fragmentation. The number of passes of the thrombectomy device was higher (p = 0.002 for trend) and the puncture-to-recanalization time was longer (p = 0.044 for trend) as the D-dimer levels increased. Patients with favorable outcome had significantly lower D-dimer levels (495.0 ng/mL [290.0-856.0]) than those without (1189.0 ng/mL [526.0-3208.0]; p < 0.001). Preprocedural D-dimer level was an independent factor for favorable outcome (adjusted odds ratio, 0.88 [0.81-0.97] per 500 ng/mL; p = 0.008). In conclusion, higher preprocedural D-dimer levels were significantly associated with poor endovascular and unfavorable functional outcomes.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.H.H.); (H.S.N.)
| | - Ji Hoe Heo
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.H.H.); (H.S.N.)
| | - Hyo Suk Nam
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.H.H.); (H.S.N.)
| | - Byung Moon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (B.M.K.); (D.J.K.)
| | - Dong Joon Kim
- Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (B.M.K.); (D.J.K.)
| | - Young Dae Kim
- Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.H.H.); (H.S.N.)
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Nam KW, Kwon HM, Lee YS. Clinical significance of D-dimer levels during acute period in ischemic stroke. Thromb J 2023; 21:55. [PMID: 37161435 PMCID: PMC10170762 DOI: 10.1186/s12959-023-00496-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Initial D-dimer level is a well-known prognostic parameter in patients with acute ischemic stroke (AIS). However, there have been no studies on the clinical significance of follow-up D-dimer levels. In this study, we evaluated the association between initial and follow-up D-dimer levels and early neurological deterioration (END) in patients with AIS. METHODS We included consecutive patients with AIS who had a positive initial D-dimer test (> 0.55 mg/L) between March 2021 and November 2022. The follow-up D-dimer test was performed on the 7th day after hospitalization and on the day of discharge if discharged earlier. END was defined as an increase of ≥ 2 in the total NIHSS score, or ≥ 1 in the motor NIHSS score within the first 7 days of admission. As medical conditions closely associated with the initial and follow-up D-dimer levels in AIS patients, we also evaluated the history of cancer, active cancer, and venous thromboembolism (VTE) that occurred during hospitalization together. RESULTS A total of 246 patients with AIS were evaluated (median age: 87 years, male: 56.5%). In multivariable logistic regression analysis, the initial D-dimer level was closely associated with END after adjusting for confounders (adjusted odds ratio [aOR]: 1.48, 95% CI: 1.06-2.05). The follow-up D-dimer level also showed a close correlation with END (aOR: 1.60, 95% CI: 1.16-2.20). Regarding the analysis of the association between D-dimer levels and underlying cancer or VTE, the initial D-dimer level showed a statistically significant positive relationship only with active cancer (P = 0.024). On the other hand, the follow-up D-dimer level was found to be statistically significantly associated with a history of cancer (P = 0.024), active cancer (P = 0.001), and VTE (P = 0.001). CONCLUSIONS Initial and follow-up D-dimer levels were associated with END in AIS patients. Particularly, the follow-up D-dimer level showed a clear correlation not only with END but also with the underlying cancer or the occurrence of VTE during the acute period.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Seok Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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Tortolini C, Gigli V, Angeloni A, Galantini L, Tasca F, Antiochia R. Disposable Voltammetric Immunosensor for D-Dimer Detection as Early Biomarker of Thromboembolic Disease and of COVID-19 Prognosis. BIOSENSORS 2022; 13:bios13010043. [PMID: 36671877 PMCID: PMC9855840 DOI: 10.3390/bios13010043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 06/12/2023]
Abstract
In this work, we report on the development of a simple electrochemical immunosensor for the detection of D-dimer protein in human plasma samples. The immunosensor is built by a simple drop-casting procedure of chitosan nanoparticles (CSNPs) as biocompatible support, Protein A (PrA), to facilitate the proper orientation of the antibody sites to epitopes as a capture biomolecule, and the D-dimer antibody onto a carboxyl functionalized multi-walled carbon nanotubes screen printed electrode (MWCNTs-SPE). The CSNPs have been morphologically characterized by Scanning Electron Microscopy (SEM) and Dynamic Light Scattering (DLS) techniques. Successively, the electrochemical properties of the screen-printed working electrode after each modification step have been characterized by differential pulse voltammetry (DPV) and electrochemical impedance spectroscopy (EIS). The resulting MWCNTs-CSNPs-PrA-D-dimer Ab immunosensor displays an optimal and promising platform for antibody immobilization and specific D-dimer detection. DPV has been used to investigate the antigen/antibody interaction at different D-dimer concentrations. The proposed voltammetric immunosensor allowed a linear range from 2 to 500 μg L-1 with a LOD of 0.6 μg L-1 and a sensitivity of 1.3 μA L μg-1 cm-2. Good stability and a fast response time (5 s) have been reported. Lastly, the performance of the voltammetric immunosensor has been tested in human plasma samples, showing satisfactory results, thus attesting to the promising feasibility of the proposed platform for detecting D-dimer in physiological samples.
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Affiliation(s)
- Cristina Tortolini
- Department of Experimental Medicine, Sapienza University of Rome, V.le Regina Elena 324, 00166 Rome, Italy
| | - Valeria Gigli
- Department of Experimental Medicine, Sapienza University of Rome, V.le Regina Elena 324, 00166 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Sapienza University of Rome, V.le Regina Elena 324, 00166 Rome, Italy
| | - Luciano Galantini
- Department of Chemistry, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Federico Tasca
- Departamento de Química de los Materiales, Facultad de Química y Biología, Universidad de Santiago de Chile, Casilla 40, Correo 33, Sucursal Matucana, Santiago 9170022, Chile
| | - Riccarda Antiochia
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
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Neurovascular Unit-Derived Extracellular Vesicles: From Their Physiopathological Roles to Their Clinical Applications in Acute Brain Injuries. Biomedicines 2022; 10:biomedicines10092147. [PMID: 36140248 PMCID: PMC9495841 DOI: 10.3390/biomedicines10092147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Extracellular vesicles (EVs) form a heterogeneous group of membrane-enclosed structures secreted by all cell types. EVs export encapsulated materials composed of proteins, lipids, and nucleic acids, making them a key mediator in cell–cell communication. In the context of the neurovascular unit (NVU), a tightly interacting multicellular brain complex, EVs play a role in intercellular communication and in maintaining NVU functionality. In addition, NVU-derived EVs can also impact peripheral tissues by crossing the blood–brain barrier (BBB) to reach the blood stream. As such, EVs have been shown to be involved in the physiopathology of numerous neurological diseases. The presence of NVU-released EVs in the systemic circulation offers an opportunity to discover new diagnostic and prognostic markers for those diseases. This review outlines the most recent studies reporting the role of NVU-derived EVs in physiological and pathological mechanisms of the NVU, focusing on neuroinflammation and neurodegenerative diseases. Then, the clinical application of EVs-containing molecules as biomarkers in acute brain injuries, such as stroke and traumatic brain injuries (TBI), is discussed.
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Retraction: Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke. PLoS One 2022; 17:e0266461. [PMID: 35353875 PMCID: PMC8967051 DOI: 10.1371/journal.pone.0266461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Retraction: The Relationship between Serum Insulin-Like Growth Factor I Levels and Ischemic Stroke Risk. PLoS One 2022; 17:e0266411. [PMID: 35353848 PMCID: PMC8967060 DOI: 10.1371/journal.pone.0266411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Retraction: Plasma D-Dimer Levels Are Associated with Stroke Subtypes and Infarction Volume in Patients with Acute Ischemic Stroke. PLoS One 2022; 17:e0266428. [PMID: 35353849 PMCID: PMC8967058 DOI: 10.1371/journal.pone.0266428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Retraction: Insulin-Like Growth Factor-1 as a Prognostic Marker in Patients with Acute Ischemic Stroke. PLoS One 2022; 17:e0266429. [PMID: 35353874 PMCID: PMC8967056 DOI: 10.1371/journal.pone.0266429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Retraction: Plasma D-Dimer Predicts Short-Term Poor Outcome after Acute Ischemic Stroke. PLoS One 2022; 17:e0266437. [PMID: 35353871 PMCID: PMC8967010 DOI: 10.1371/journal.pone.0266437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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High D-dimer concentration is a significant independent prognostic factor in patients with acute large vessel occlusion undergoing endovascular thrombectomy. World Neurosurg 2022; 160:e487-e493. [PMID: 35074546 DOI: 10.1016/j.wneu.2022.01.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/12/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate prognostic factors that affect modified Rankin Scale (mRS) score at 3 months after onset in acute stroke patients with large vessel occlusion (LVO) undergoing endovascular thrombectomy. METHODS We retrospectively examined 87 consecutive patients who underwent endovascular cerebral thrombectomy for acute anterior circulation LVO at Oita University Hospital and Nagatomi Neurosurgery Hospital from January 2014 to December 2020. RESULTS Age, National Institutes of Health Stroke Scale (NIHSS) score, and D-dimer concentration on admission were significant univariate prognostic factors related to mRS score 3 months after stroke onset. Multivariate logistic regression analysis showed that D-dimer concentration was the only significant independent prognostic factor. The area under the receiver operating characteristic curve for D-dimer concentration and mRS score at 3 months was 0.715 (95% confidence interval, 0.599 - 0.831); sensitivity and specificity were 60.6% and 80.0%, respectively, using a 1.9 μg/mL cutoff value. CONCLUSIONS Prognosis may be worse in patients undergoing acute endovascular cerebral thrombectomy with high D-dimer concentration on admission. Other treatment options should be considered for these patients.
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Jin T, Chen D, Chen Z, Feng D, Zheng M, Wang P, Xu C. Post-Thrombolytic D-Dimer Elevation Predicts Symptomatic Intracranial Hemorrhage and Poor Functional Outcome After Intravenous Thrombolysis in Acute Ischemic Stroke Patients. Neuropsychiatr Dis Treat 2022; 18:2737-2745. [PMID: 36444217 PMCID: PMC9700443 DOI: 10.2147/ndt.s389469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of post-thrombolytic D-dimer elevation with symptomatic intracranial hemorrhage (sICH) and functional outcome in AIS patients receiving intravenous thrombolysis. METHODS We retrospectively reviewed our database for patients with AIS who received intravenous thrombolysis between August 2018 and December 2021. ΔD-dimer was calculated as follow-up D-dimer minus baseline D-dimer. Poor functional outcome was defined as 3 months modified Rankin score (mRS) 3-6. sICH was defined as cerebral hemorrhagic transformation in combination with clinical deterioration of National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 24 hours. Binary logistic regression analysis was used to investigate the association of post-thrombolytic D-dimer parameters with sICH and poor functional outcome. The receiver operating characteristic (ROC) curve derived optimal cut-off of different D-dimer parameters was determined at the maximal Youden's Index. RESULTS A total of 325 patients were finally included. After controlling for clinical variables, follow-up D-dimer level (OR 1.230; 95% CI 1.119 to 1.351; P < 0.001) and ΔD-dimer (OR 1.347; 95% CI 1.165 to 1.559; P < 0.001) were independently associated with poor functional outcome. Additionally, follow-up D-dimer level (OR 1.095; 95% CI 1.009 to 1.188; P = 0.030) was independently related to sICH. The optimal cut-off value of follow-up D-dimer level for predicting sICH was 4185 μg/L (area under the curve 0.760; sensitivity 76.0%; specificity 81.3%); and the optimal cut-off value of follow-up D-dimer level and ΔD-dimer as a predictor for poor functional outcome was projected to be 3838 μg/L and 2190 μg/L, which yielded a sensitivity and a specificity of 62.3%, 84.5% and 73.8%, 85.2%, respectively. CONCLUSION Elevated follow-up D-dimer levels are associated with sICH and poor functional outcome in AIS patients following intravenous rt-PA. Moreover, post-thrombolytic D-dimer elevation, measured by ΔD-dimer, was a better predictive biomarker for long-term outcome at 3 months.
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Affiliation(s)
- Tianyu Jin
- Department of Neurology, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Danyu Chen
- Department of Neurology, Tongxiang First People's Hospital, Tongxiang, People's Republic of China
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Dujin Feng
- Department of Laboratory, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Manqi Zheng
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, People's Republic of China
| | - Peng Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Chao Xu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, People's Republic of China
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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Hu L, Duan G, Xu Y, Cao Y. Prognostic analysis of different therapeutic regimens in patients with acute cardiogenic cerebral embolism. BMC Neurol 2021; 21:325. [PMID: 34425782 PMCID: PMC8381572 DOI: 10.1186/s12883-021-02348-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Few studies focused on the functional outcomes of patients at 3 months after receiving intravenous thrombolysis, anticoagulation, or antiplatelet therapy within 4.5 h of onset of the cardiogenic cerebral embolism (CCE) subtype. METHODS The purpose of this retrospective study was to analyse the clinical data of patients with acute CCE and compare the 3-month functional prognoses of patients after administration of different antithrombotic therapies within 4.5 h of stroke onset. A total of 335 patients with CCE hospitalized in our institution were included in this study. The patients were stratified according to the hyperacute treatment received, and baseline clinical and laboratory data were analysed. A 3-month modified Rankin scale (mRS) score of 0-2 was defined as an excellent functional outcome. RESULTS A total of 335 patients were divided into thrombolytic (n = 78), anticoagulant (n = 88), and antiplatelet therapy groups (n = 169). A total of 164 patients had a good prognosis at 3 months (mRS ≤ 2). After adjustments were made for age and National Institute of Health Stroke Scale (NIHSS) score, each group comprised 38 patients, and there were no significant differences in sex composition, complications, lesion characteristics, or Oxfordshire Community Stroke Project (OSCP) classification among the three groups. The plasma D-dimer level (µg/ml) in the thrombolytic group was significantly higher than those in the anticoagulant and antiplatelet groups [3.07 (1.50,5.62), 1.33 (0.95,1.89), 1.61 (0.76,2.96), P < 0.001]. After one week of treatment, the reduction in NIHSS in the thrombolytic group was significantly greater than those in the other two groups [3.00 (1.00, 8.00), 1.00 (0.00, 5.00), 1.00 (0.00, 2.00), P = 0.025]. A total of 47 patients (41.2 %) had an mRS score of ≤ 2 at 3 months, and 23 patients died (20.2 %). There was no significant difference in the proportion of patients with a good prognosis or the mortality rate among the three groups (P = 0.363, P = 0.683). CONCLUSIONS Thrombolytic therapy is effective at improving short-term and 3-month prognoses. Anticoagulant therapy may be a safe and effective treatment option for patients with the cardiac stroke subtype who fail to receive intravenous recombinant tissue plasminogen activator (r-tPA) thrombolysis within 4.5 h in addition to antiplatelet therapy, as recommended by the guidelines.
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Affiliation(s)
- Lan Hu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gaoxin District, Room 406, Building 12, Jinyi Garden, Jiangxing West Road, Songling Town, Wujiang District, Jiangsu Province 215004 Suzhou, China
- Department of Neurology, The Ninth People’s Hospital of Soochow University, 2666 Ludang Road, Wujiang District, 215200 Suzhou, Jiangsu Province China
| | - Guangxin Duan
- Department of Neurology, Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, Jiangsu Province China
| | - Yuan Xu
- Department of Neurology, The Ninth People’s Hospital of Soochow University, 2666 Ludang Road, Wujiang District, 215200 Suzhou, Jiangsu Province China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gaoxin District, Room 406, Building 12, Jinyi Garden, Jiangxing West Road, Songling Town, Wujiang District, Jiangsu Province 215004 Suzhou, China
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Zhang P, Wang C, Wu J, Zhang S. A Systematic Review of the Predictive Value of Plasma D-Dimer Levels for Predicting Stroke Outcome. Front Neurol 2021; 12:693524. [PMID: 34295302 PMCID: PMC8289899 DOI: 10.3389/fneur.2021.693524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Stroke is a leading cause of morbidity and mortality. Over the past decade, plasma D-dimer levels have emerged as a biomarker for predicting stroke outcome. However, no consensus in the literature currently exists concerning its utility for predicting post-stroke functional outcome and mortality. Objective: To systematically review the effectiveness of plasma D-dimer levels for predicting functional outcome and mortality following stroke. Methods: Five academic databases were screened according to PRISMA guidelines for eligible studies. With these studies, we conducted a random-effect meta-analysis to evaluate the impact of plasma D-dimer levels for predicting functional outcome and mortality post-stroke. We also conducted subgroup analyses to evaluate differences in predictive capacity for different stroke subtypes. Results: Nineteen studies were included, containing data on 5,781 stroke patients (mean age: 65.26 ± 6.4 years). Overall methodological quality for the included studies was high. Meta-analysis showed that increased D-dimer levels were predictive of worsened functional outcomes (Hazard ratio: 2.19, 95% CI: 1.63-2.93) and elevated overall mortality (2.29, 1.35-3.88). Subgroup analysis showed that plasma D-dimer levels were more predictive of poorer functional outcomes for ischemic (2.08, 1.36-3.18) stroke as compared to intracerebral hemorrhage (2.62, 1.65-4.17). We also noted that predictive capacity was similar when it came to mortality in patients with cryptogenic ischemic stroke (2.65, 0.87-8.08) and intracerebral hemorrhage (2.63, 1.50-4.59). Conclusion: The study provides preliminary evidence concerning the capacity of plasma D-dimer levels for predicting functional outcomes and mortality following stroke and reports that higher D-dimer levels of are associated with poorer functional outcomes and higher mortality.
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Affiliation(s)
- Peng Zhang
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Chun Wang
- Department of Cardiology, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
| | - Junhua Wu
- Department of Cardiovascular and Cerebrovascular, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
| | - Shiliang Zhang
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
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Immune-inflammatory, coagulation, adhesion, and imaging biomarkers combined in machine learning models improve the prediction of death 1 year after ischemic stroke. Clin Exp Med 2021; 22:111-123. [PMID: 34120242 DOI: 10.1007/s10238-021-00732-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/04/2021] [Indexed: 01/02/2023]
Abstract
Some clinical, imaging, and laboratory biomarkers have been identified as predictors of prognosis of acute ischemic stroke (IS). The aim of this study was to evaluate the prognostic validity of a combination of clinical, imaging, and laboratory biomarkers in predicting 1-year mortality of IS. We evaluated 103 patients with IS within 24 h of their hospital admission and assessed demographic data, IS severity using the National Institutes of Health Stroke Scale (NIHSS), carotid intima-media thickness (cIMT), and degree of stenosis, as well as laboratory variables including immune-inflammatory, coagulation, and endothelial dysfunction biomarkers. The IS patients were categorized as survivors and non-survivors 1 year after admission. Non-survivors showed higher NIHSS and cIMT values, lower antithrombin, Protein C, platelet counts, and albumin, and higher Factor VIII, von Willebrand Factor (vWF), white blood cells, tumor necrosis factor (TNF)-α, interleukin (IL)-10, high-sensitivity C-reactive protein (hsCRP), and vascular cellular adhesion molecule 1 (VCAM-1) than survivors. Neural network models separated non-survivors from survivors using NIHSS, cIMT, age, IL-6, TNF-α, hsCRP, Protein C, Protein S, vWF, and platelet endothelial cell adhesion molecule 1 (PECAM-1) with an area under the receiving operating characteristics curve (AUC/ROC) of 0.975, cross-validated accuracy of 93.3%, sensitivity of 100% and specificity of 85.7%. In conclusion, imaging, immune-inflammatory, and coagulation biomarkers add predictive information to the NIHSS clinical score and these biomarkers in combination may act as predictors of 1-year mortality after IS. An early prediction of IS outcome is important for personalized therapeutic strategies that may improve the outcome of IS.
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Yuan B, Yang T, Yan T, Cheng W, Bu X. Relationships Between D-Dimer Levels and Stroke Risk as Well as Adverse Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:670730. [PMID: 34163426 PMCID: PMC8215146 DOI: 10.3389/fneur.2021.670730] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Abnormal elevation of D-dimer levels is an important indicator of disseminated intravascular clotting. Therefore, we hypothesized that high D-dimer levels were associated with the risk of stroke and adverse clinical outcomes of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods: The present meta-analysis aimed to systematically analyze the associations between D-dimer and the risk of stroke as well as the clinical outcomes of patients with post-stroke or TIA. Meanwhile, dose–response analyses were conducted when there were sufficient data available. Three electronic databases including Pubmed, the Embase database, and the Cochrane Library were searched by two investigators independently. All the pooled results were expressed as risk ratios (RRs). Results: Finally, 22 prospective cohort studies were included into this meta-analysis. The results suggested that high D-dimer levels were associated with increased risks of total stroke (RR 1.4, 95%CI 1.20–1.63), hemorrhagic stroke (RR 1.25, 95%CI 0.69–2.25), and ischemic Stroke (RR 1.55, 95%CI 1.22–1.98), and the dose-dependent relationship was not found upon dose–response analyses. Besides, the high D-dimer levels on admission were correlated with increased risks of all-cause mortality [RR 1.77, 95% confidence interval (CI) 1.26–2.49], 5-day recurrence (RR 2.28, 95%CI 1.32–3.95), and poor functional outcomes (RR 2.01, 95%CI 1.71–2.36) in patients with AIS or TIA. Conclusions: On the whole, high D-dimer levels may be associated with the risks of total stroke and ischemic stroke, but not with hemorrhagic stroke. However, dose–response analyses do not reveal distinct evidence for a dose-dependent association of D-dimer levels with the risk of stroke. Besides, high D-dimer levels on admission may predict adverse clinical outcomes, including all-cause mortality, 5-day recurrence, and 90-day poor functional outcomes, of patients with AIS or TIA. More studies are warranted to quantify the effect of D-dimer levels on the risk of stroke or TIA, so as to verify and substantiate this conclusion in the future.
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Affiliation(s)
- Bing Yuan
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Tong Yang
- Department of Hyperbaric Oxygen, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Tao Yan
- Department of Emergency, Taierzhuang District People's Hospital, Zaozhuang, China
| | - Wenke Cheng
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Xiancong Bu
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
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17
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Yang X, Lu T, Qu Z, Zhang Y, Liu P, Ma Y. Plasma D-dimer level is associated with clinical outcomes in patients with atrial fibrillation related acute ischemic stroke after pneumonia. BMC Neurol 2021; 21:137. [PMID: 33773590 PMCID: PMC8004437 DOI: 10.1186/s12883-021-02168-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Pneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer. The aim of our study was to investigate the prognostic value of D-dimer for predicting clinical outcome of AF-related AIS with pneumonia. Method AF-related AIS patients with pneumonia were prospectively enrolled. Receiver operating characteristic (ROC) curve was used to determine the optimal D-dimer point for 3-month mortality and death/severe disability. The associations between the D-dimer and 3-month mortality and death/severe disability were assessed by multivariable logistic regression analysis. Results A total of 415 patients were enrolled in this study. ROC curve analysis showed that the optimal cut point of D-dimer for 3-month death/severe disability and mortality were D-dimer≥2.35 mg/l and D-dimer≥3.35 mg/l, respectively. Multivariable logistic regression analysis showed that D-dimer≥2.35 mg/l [adjusted odds ratio (aOR) 5.99, 95% confidence interval (CI): 3.04–11.83, P<0.001], higher NIHISS score (aOR:1.53, 95% CI: 1.38–1.69, P<0.001) and larger infarct volume (aOR 1.01, 95% CI: 1.01–1.02, P<0.001) were associated with increased risk of 3-month death/severe disability), and anticoagulant was associated with decreased risk of death/severe disability (aOR:0.21, 95% CI: 0.09–0.47, P<0.001). Higher NIHISS score (aOR:1.64, 95% CI: 1.38–1.94, P<0.001), older age (aOR 1.08, 95% CI: 1.02–1.14, P = 0.007), D-dimer≥3.35 mg/l (OR 8.49, 95% CI: 4.13–17.84,P<0.001), larger infarct volume (aOR 1.02, 95% CI: 1.00–1.03, P = 0.014), and higher CRUB-65 score (aOR 6.43, 95% CI: 3.10–13.34, P<0.001) were associated with increased risk of 3-month mortality. Conclusions AF-related AIS patients with concurrent high D-dimer and pneumonia increased risk of 3-month mortality and death/severe disability, plasma D-dimer may have predictive value in outcome after AF-related AIS with pneumonia.
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Affiliation(s)
- Xu Yang
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China.
| | - Taoli Lu
- Department of Neurology, Chengdu second people's hospital, Chengdu, 610015, Sichuan, China
| | - Zhanli Qu
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Yi Zhang
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Pingping Liu
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Ying Ma
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
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18
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Hou H, Xiang X, Pan Y, Li H, Meng X, Wang Y. Association of Level and Increase in D-Dimer With All-Cause Death and Poor Functional Outcome After Ischemic Stroke or Transient Ischemic Attack. J Am Heart Assoc 2021; 10:e018600. [PMID: 33412918 PMCID: PMC7955415 DOI: 10.1161/jaha.120.018600] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background D‐dimer is involved in poor outcomes of stroke as a coagulation biomarker. We aimed to investigate the associations of the level and increase in D‐dimer between baseline and 90 days with all‐cause death or poor functional outcome in patients after ischemic stroke or transient ischemic attack. Methods and Results We collected data from the CNSRIII (Third China National Stroke Registry) study. The present substudy included 10 518 patients within 7 days (baseline) of ischemic stroke or transient ischemic attack and 6268 patients at 90 days. Poor functional outcome at 1 year was assessed on the basis of the modified Rankin Scale (≥3). Multivariable Cox regression or logistic regression was used to assess the association of D‐dimer levels with all‐cause death or poor functional outcome. D‐dimer levels at 90 days were lower than those at baseline (1.4 µg/mL versus 1.7 µg/mL; P<0.001). Higher baseline D‐dimer level was associated with all‐cause death (adjusted hazard ratio [HR], 1.77; 95% CI, 1.25–2.52; P=0.001) and poor functional outcome (adjusted odds ratio [OR], 1.49; 95% CI, 1.23–1.80; P<0.001) during 1‐year follow‐up. Higher D‐dimer level at 90 days was also associated with poor outcomes independently. Furthermore, an increase in D‐dimer levels between baseline and 90 days was associated with all‐cause death (since 90 days to 1 year after index event) (adjusted HR, 1.99; 95% CI, 1.12–3.53; P=0.019) but not with poor functional outcome (adjusted OR, 1.08; 95% CI, 0.82–1.41). Conclusions Our study shows that high level and an increase in D‐dimer between baseline and 90 days are associated with poor outcomes in patients after ischemic stroke or transient ischemic attack.
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Affiliation(s)
- Huiqing Hou
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China.,Department of Neurology the Second Hospital of Hebei Medical University Shijiazhuang China
| | - Xianglong Xiang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China
| | - Yuesong Pan
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China
| | - Hao Li
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China
| | - Xia Meng
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China
| | - Yongjun Wang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Center of Stroke Beijing Institute for Brain Disorders China
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19
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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; 25:193-198. [PMID: 33707899 PMCID: PMC7922437 DOI: 10.5005/jp-journals-10071-23744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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Affiliation(s)
- Nora I Abbas
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Sayed
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif Samir
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nashwa Abeed
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Nezu T, Hosomi N, Yoshimura K, Kuzume D, Naito H, Aoki S, Morimoto Y, Kinboshi M, Yoshida T, Shiga Y, Kinoshita N, Furui A, Tabuchi G, Ueno H, Tsuji T, Maruyama H. Predictors of Stroke Outcome Extracted from Multivariate Linear Discriminant Analysis or Neural Network Analysis. J Atheroscler Thromb 2020; 29:99-110. [PMID: 33298664 PMCID: PMC8737069 DOI: 10.5551/jat.59642] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim:
The prediction of functional outcome is essential in the management of acute ischemic stroke patients. We aimed to explore the various prognostic factors with multivariate linear discriminant analysis or neural network analysis and evaluate the associations between candidate factors, baseline characteristics, and outcome.
Methods:
Acute ischemic stroke patients (
n
=1,916) with premorbid modified Rankin Scale (mRS) scores of 0–2 were analyzed. The prediction models with multivariate linear discriminant analysis (quantification theory type II) and neural network analysis (log-linearized Gaussian mixture network) were used to predict poor functional outcome (mRS 3–6 at 3 months) with various prognostic factors added to age, sex, and initial neurological severity at admission.
Results:
Both models revealed that several nutritional statuses and serum alkaline phosphatase (ALP) levels at admission improved the predictive ability. Of the 1,484 patients without missing data, 560 patients (37.7%) had poor outcomes. The patients with poor outcomes had higher ALP levels than those without (294.3±259.5 vs. 246.3±92.5 U/l,
P
<0.001). Multivariable logistic analyses revealed that higher ALP levels (1-SD increase) were independently associated with poor stroke outcomes after adjusting for several confounding factors, including the neurological severity, malnutrition status, and inflammation (odds ratio 1.21, 95% confidence interval 1.02–1.49). Several nutritional indicators extracted from prediction models were also associated with poor outcome.
Conclusion:
Both the multivariate linear discriminant and neural network analyses identified the same indicators, such as nutritional status and serum ALP levels. These indicators were independently associated with functional stroke outcome.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital.,Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University
| | | | | | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | | | | | | | - Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Naoto Kinoshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Akira Furui
- Faculty of Engineering, Hiroshima University
| | | | - Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
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21
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Wang J, Feng A, Xu J, Liu Y, Li F, Sun Y, Sun H, Yang F, Zhao J, Tang Y. D-dimer and its Combination with Blood Lipid on Prognosis of Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:105394. [PMID: 33096493 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies indicate that the levels of d-dimer and blood lipids at admission affect the prognosis of patients with acute ischemic stroke (AIS), however, whether there is a dose-response effect of d-dimer on prognosis, or a combined effect of d-dimer with blood lipids on prognosis, remains unclear. METHODS In this prospective cohort study, 1485 AIS patients were recruited. All participants received medical care within 24 h from the onset of stroke, the level of d-dimer and related indices were measured at admission. Then, National Institutes of Health Stroke Scale (NIHSS) scores were obtained at the time of admission and discharge. Afterwards, 3-, 6- and 12- month follow-up was conducted to obtain Modified Rankin Scale (mRS) scores after discharge. RESULTS A high level of d-dimer at admission was associated with clinical outcome of AIS, after adjusting other relevant factors, with an OR (95%CI) of 2.934(1.914-4.500), 3.052(1.912-4.872), 3.306(1.873-5.835) and 2.828(1.447-5.527) at discharge, at 3-, 6-, and 12-month follow-up respectively, a dose-response effect was observed during follow-up (p = 0.00001). When d-dimer was combined with total cholesterol (TC), after adjusting other relevant factors, OR (95%CI) was 2.799 (1.708-4.587), 2.473 (1.475-4.147), 2.381 (1.333-4.255), and 2.619 (1.320-5.193), at each follow-up period respectively. When combined with low-density lipoprotein (LDL), OR (95%CI) was 3.105 (1.729-5.577), 3.280 (1.762-6.104), 2.744 (1.344-5.604), and 4.400 (1.883-10.282), respectively. CONCLUSIONS D-dimer levels at admission may predict the prognosis of AIS patients in a dose-response pattern. Moreover, d-dimer combined with TC or LDL predict prognosis of AIS.
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Affiliation(s)
- Jiamin Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China
| | - Anqi Feng
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China
| | - Jia Xu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China
| | - Yue Liu
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fang Li
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanyan Sun
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongwei Sun
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fan Yang
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingbo Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.
| | - Ying Tang
- Department of Neurology, the first Affiliated Hospital of Harbin Medical University, Harbin, China.
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22
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Donkel SJ, Benaddi B, Dippel DWJ, Ten Cate H, de Maat MPM. Prognostic Hemostasis Biomarkers in Acute Ischemic Stroke. Arterioscler Thromb Vasc Biol 2020; 39:360-372. [PMID: 30700129 PMCID: PMC6392207 DOI: 10.1161/atvbaha.118.312102] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Objectives— The prediction of patients at risk for poor clinical outcome after acute ischemic stroke remains challenging. An imbalance of coagulation factors may play an important role in progression and prognosis of these patients. In this systematic review, we assessed the current literature on hemostasis biomarkers and the association with poor clinical outcome in acute ischemic stroke. Approach and Results— A systematic search of Embase, Medline, Cochrane Library, Web of Science, and Google Scholar was performed on studies reporting on hemostasis biomarkers and clinical outcome after acute ischemic stroke. Studies were considered eligible if blood samples were collected within 72 hours after symptom onset. Additionally, clinical outcome should be assessed using a disability score (Barthel Index or modified Rankin scale). Methodological quality of included studies was assessed with an adapted version of the Quality Assessment of Diagnostic Accuracy Studies questionnaire. A total of 80 articles were read full text, and 41 studies were considered eligible for inclusion, reporting on 37 different hemostasis biomarkers. No single biomarker appeared to be effective in predicting poor clinical outcome in acute ischemic stroke patients. Conclusions— Based on current literature, no clear recommendations can be provided on which hemostasis biomarkers are a predictor of clinical outcome after acute ischemic stroke. However, some biomarkers show promising results and need to be further investigated and validated in large populations with clear defined study designs.
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Affiliation(s)
- Samantha J Donkel
- From the Departments of Hematology (S.J.D., B.B., M.P.M.d.M.), Erasmus University Medical Center Rotterdam, The Netherlands
| | - Boutaina Benaddi
- From the Departments of Hematology (S.J.D., B.B., M.P.M.d.M.), Erasmus University Medical Center Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Neurology (D.W.J.D.), Erasmus University Medical Center Rotterdam, The Netherlands
| | - Hugo Ten Cate
- CARIM School for Cardiovascular Diseases (H.t.C.), Maastricht University Medical Centre, The Netherlands.,Laboratory for Clinical Thrombosis & Haemostasis, Department of Internal Medicine (H.t.C.), Maastricht University Medical Centre, The Netherlands
| | - Moniek P M de Maat
- From the Departments of Hematology (S.J.D., B.B., M.P.M.d.M.), Erasmus University Medical Center Rotterdam, The Netherlands
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23
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Rudolf JW, Baron JM, Dighe AS. Order Indication Solicitation to Assess Clinical Laboratory Test Utilization: D-Dimer Order Patterns as an Illustrative Case. J Pathol Inform 2019; 10:36. [PMID: 31897353 PMCID: PMC6909549 DOI: 10.4103/jpi.jpi_46_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/10/2019] [Indexed: 11/07/2022] Open
Abstract
Background: A common challenge in the development of laboratory clinical decision support (CDS) and laboratory utilization management (UM) initiatives stems from the fact that many laboratory tests have multiple potential indications, limiting the ability to develop context-specific alerts. As a potential solution, we designed a CDS alert that asks the ordering clinician to provide the indication for testing, using D-dimer as an exemplar. Using data collected over a nearly 3-year period, we sought to determine whether the indication capture was a useful feature within the CDS alert and whether it provided actionable intelligence to guide the development of an UM strategy. Methods: We extracted results and ordering data for D-dimer testing performed in our laboratory over a 35-month period. We analyzed order patterns by clinical indication, hospital service, and length of hospitalization. Results: Our final data set included 13,971 result-order combinations and indeed provided actionable intelligence regarding test utilization patterns. For example, pulmonary embolism was the most common emergency department indication (86%), while disseminated intravascular coagulation was the most common inpatient indication (56%). D-dimer positivity rates increased with the duration of hospitalization and our data suggested limited utility for ordering this test in the setting of suspected venous thromboembolic disease in admitted patients. In addition, we found that D-dimer was ordered for unexpected indications including the assessment of stroke, dissection, and extracorporeal membrane oxygenation. Conclusions: Indication capture within a CDS alert and correlation with result data can provide insight into order patterns which can be used to develop future CDS strategies to guide appropriate test use by clinical indication.
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Affiliation(s)
- Joseph W Rudolf
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M Baron
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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24
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Zhang J, Liu L, Tao J, Song Y, Fan Y, Gou M, Xu J. Prognostic role of early D-dimer level in patients with acute ischemic stroke. PLoS One 2019; 14:e0211458. [PMID: 30707716 PMCID: PMC6358072 DOI: 10.1371/journal.pone.0211458] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/15/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECT The purpose of our study was to assess the prognostic role of early D-dimer level in patients with acute ischemic stroke (AIS). METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Jing Zhang
- Department of Neurosurgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lin Liu
- Department of Neurosurgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, Sichuan, PR China
| | - Jie Tao
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, PR China
| | - Yanlin Song
- Department of Neurosurgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yimeng Fan
- Department of Neurosurgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Maling Gou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, PR China
| | - Jianguo Xu
- Department of Neurosurgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- * E-mail:
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25
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You LR, Tang M. The association of high D-dimer level with high risk of ischemic stroke in nonvalvular atrial fibrillation patients: A retrospective study. Medicine (Baltimore) 2018; 97:e12622. [PMID: 30412062 PMCID: PMC6221672 DOI: 10.1097/md.0000000000012622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to explore the relationship of D-dimer level with the risk stratification of ischemic stroke, and determine whether high D-dimer levels could be used as a risk factor of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF).This single-center, retrospective study recruited NVAF patients who did not undergo anticoagulant therapy. These patients were divided into 2 groups: ischemic stroke group and no-stroke group. The medical records of each patient were reviewed, demographic and clinical analyses were performed, and the laboratory results were summarized.A total of 323 eligible in-patients with NVAF, who did not receive anticoagulant therapy, were recruited (206 male and 117 female patients, median age was 75.18 ± 10.46 years old). Among these patients, 78 patients suffered from acute ischemic stroke. D-dimer level increased with age, and was positively correlated with the risk stratification of stroke, CHADS2 score (rs = 0.441, P < .001), and CHA2DS2-VASC score (rs = 0.412, P < .001), even after adjustment for age and gender (rs = 0.422, P < .001). The difference in baseline D-dimer level between these 2 groups was not statistically significant (0.70 vs 0.66 mg/L, P = .330), but this significantly increased when patients suffered from stroke (1.34 vs 0.70 mg/L, P < .001). The D-dimer level after stroke (≥6 months) was also higher than the baseline (1.16 vs 0.68 mg/L, P = .514) in 6 months, and this level nearly returned to baseline level after one year (0.69 vs 0.68 mg/L, P = .158). However, logistic regression revealed that only the D-dimer level at stroke onset and OMI were independent risk factors for ischemic stroke (P < .001), while the increase from baseline D-dimer levels was not an independent risk factor (P = .125).D-dimer level is positively correlated with the risk stratification of ischemic stroke, but has no predictive value on the occurrence of ischemic stroke in patients with NVAF.
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Affiliation(s)
- Li-Rui You
- Department of Geriatric, Medical Care Centre, Beijing Friendship Hospital, Captial Medical University
- Department of Internal Medicine, Beijing Norther Hospital, Beijing, China
| | - Mei Tang
- Department of Geriatric, Medical Care Centre, Beijing Friendship Hospital, Captial Medical University
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Huţanu A, Iancu M, Bălaşa R, Maier S, Dobreanu M. Predicting functional outcome of ischemic stroke patients in Romania based on plasma CRP, sTNFR-1, D-Dimers, NGAL and NSE measured using a biochip array. Acta Pharmacol Sin 2018; 39:1228-1236. [PMID: 29926842 DOI: 10.1038/aps.2018.26] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/19/2018] [Indexed: 02/06/2023] Open
Abstract
In cerebral ischemia, evaluation of multiple biomarkers involved in various pathological pathways is a useful tool in assessing the outcome of the patients even from the early stages of the disease. In this study we investigated the utility of a panel of 5 peripheral biomarkers of inflammatory status, neuronal destruction and secondary fibrinolysis in the acute phase of ischemia, and evaluated the impact of these biomarkers on functional outcome after ischemic stroke. The 5 biomarkers (plasma CRP, D-Dimers, sTNFR-1, NGAL and NSE) were measured using a biochip array technology. Eighty nine patients in Romania were divided into 2 subgroups using the modified Rankin Scale evaluated at 3 months after ischemic stroke; the possible impact of analyzed biomarkers on unfavorable functional outcome was tested by binomial logistic regression. The subgroup with unfavorable outcome had higher concentrations of CRP, NGAL, sTNFR-1 and D-dimers, but CRP and NGAL values were not statistically different between the two subgroups. The univariate logistic regression analysis of plasma biomarkers revealed that CRP, D-Dimers, NGAL, sTNFR-1 were significant predictors of unfavorable clinical outcome. In the case of D-Dimers and sTNFR-1 we noticed an increased discrimination ability (versus baseline clinical model) to classify poor functional outcome with a tendency toward statistical signification. During the acute phase of the ischemic stroke, plasma concentrations of CRP, D-Dimers and sTNFR-1 were elevated in unfavorable outcome patients. D-Dimers and sTNFR-1 were independent predictors of poor outcome at 3 months after ischemic stroke. The biochip array technology offers the possibility to simultaneously measure several parameters involved in multiple pathophysiological pathways, in a small sample volume.
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Contribution of routine cardiac biological markers to the etiological workup of ischemic stroke. Am J Emerg Med 2018; 37:194-198. [PMID: 29804788 DOI: 10.1016/j.ajem.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Optimization of the detection of atrial fibrillation following stroke is mandatory. Unfortunately, access to long-term cardiac monitoring is limited in many centers. The aim of this study was to assess the potential usefulness of three routine biological markers, troponin, D-dimers and BNP, measured in acute stroke phase in the selection of patients at risk of cardio-embolic stroke. METHODS Troponin, D-Dimers and BNP were measured within 48 h after admission for ischemic stroke in 634 patients. Stroke mechanism was defined at the 3 months follow-up visit using ASCOD classification using a standardized work-up. Association between clinical, radiological and biological markers and stroke mechanism was evaluated using logistic regression analyses. RESULTS 159 patients (25.1% of total study population) had a cardiac mechanism. On multivariate analysis, admission initial stroke severity (OR 1.04, 95 CI% 1.004-1.07, p < 0.05) history of heart failure (OR 3.03, 95% CI 1.19-7.73, p < 0.05), ECG abnormalities and high BNP value (OR 4.34, 95% CI 2.59-7.29, p < 0.05) were associated with pure cardiac stroke mechanism. CONCLUSION High BNP value measured within 48 h after stroke admission is an independent predictor of cardiac stroke mechanism. Its measurement might be used to improve the selection of patients for whom further cardiologic investigations such as continuous long term ECG monitoring would be the most useful. BNP should be added to the standard admission-work-up for stroke patients.
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Zheng J, Cheng C, Zhou C, Chen H, Guo Z, Sun X. The Clinical Value of d-Dimer Level in Patients with Nonaneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 114:e1161-e1167. [PMID: 29614358 DOI: 10.1016/j.wneu.2018.03.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE More nonaneurysmal subarachnoid hemorrhage (NaSAH) are found in clinical practice. However, the precise mechanisms in which d-dimer level is associated with clinical condition in patients with NaSAH remain unclear. But even more, the data assessing the risk of clinical course in the patients with NaSAH are scarce. Our objective was to investigate whether d-dimer levels correlated with complication and outcome in patients with NaSAH. METHODS Between February 2013 and May 2017, 92 patients suffering from NaSAH were treated in our hospital. Patient characteristics, radiologic features, laboratory findings, complications, and outcomes were analyzed retrospectively. Patients were stratified into the perimesencephalic (PM) subarachnoid hemorrhage (SAH) group and the nonperimesencephalic (NPM) SAH group according to the bleeding type, and the NPM-SAH group was further divided into 2 subgroups into the NPM-elevated group and the NPM-normal group based on the value of the d-dimer. After statistical analysis, the NPM-SAH and PM-SAH groups were compared; the same was true for the NPM-elevated group and the NPM-normal group. RESULTS The rate of complications in the NPM-SAH group was higher than in the PM-SAH group, including early hydrocephalus, delayed cerebral ischemia, clinical vasospasm, pneumonia, and hyponatremia. Our results showed that d-dimer levels in patients with NPM-SAH were more elevated than in those with PM-SAH. Further analysis of subgroups demonstrated that patients with elevated d-dimer levels had a higher incidence of complications than those with normal d-dimer levels, especially the risks of shunt-dependent hydrocephalus and pneumonia. In addition, disability, and even death, could be seen in patients with higher levels of d-dimer, but the long-term outcomes were not particularly obvious between these groups. CONCLUSIONS Elevated d-dimer levels on admission were significantly associated with complication in patients with NPM-SAH. In addition to conventional radiologic diagnosis, d-dimer levels can increase the ability of a rapid differential diagnosis between NPM-SAH and PM-SAH.
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Affiliation(s)
- Jianfeng Zheng
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China
| | - Chongjie Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China
| | - Chao Zhou
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China
| | - Hong Chen
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China
| | - Zongduo Guo
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China.
| | - Xiaochuan Sun
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China.
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Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients. J Neurol 2018; 265:628-636. [DOI: 10.1007/s00415-018-8742-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 01/08/2023]
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Dagonnier M, Cooke IR, Faou P, Sidon TK, Dewey HM, Donnan GA, Howells DW. Discovery and Longitudinal Evaluation of Candidate Biomarkers for Ischaemic Stroke by Mass Spectrometry-Based Proteomics. Biomark Insights 2017; 12:1177271917749216. [PMID: 29308009 PMCID: PMC5751906 DOI: 10.1177/1177271917749216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/11/2017] [Indexed: 01/17/2023] Open
Abstract
Application of acute therapies such as thrombolysis for ischaemic stroke (IS) is constrained because of diagnostic uncertainty and the dynamic nature of stroke biology. To investigate changes in blood proteins after stroke and as a result of thrombolysis treatment we performed label-free quantitative proteomics on serum samples using high-resolution mass spectrometry and long high-performance liquid chromatography gradient (5 hours) combined with a 50-cm column to optimise the peptide separation. We identified (false discovery rate [FDR]: 1%) and quantified a total of 574 protein groups from a total of 92 samples from 30 patients. Ten patients were treated by thrombolysis as part of a randomised placebo-controlled trial and up to 5 samples were collected from each individual at different time points after stroke. We identified 26 proteins differently expressed by treatment group (FDR: 5%) and significant changes of expression over time for 23 proteins (FDR: 10%). Molecules such as fibrinogen and C-reactive protein showed expression profiles with a high-potential clinical utility in the acute stroke setting. Protein expression profiles vary acutely in the blood after stroke and have the potential to allow the construction of a stroke clock and to have an impact on IS treatment decision making.
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Affiliation(s)
- Marie Dagonnier
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Ira Robin Cooke
- La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia.,Life Sciences Computation Centre, Victorian Life Sciences Computation Initiative, La Trobe University, Melbourne, VIC, Australia
| | - Pierre Faou
- La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - Tara Kate Sidon
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Helen Margaret Dewey
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Geoffrey Alan Donnan
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - David William Howells
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia.,School of Medicine, Faculty of Health, University of Tasmania, Hobart, TAS, Australia
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Nomura M, Ota T, Ishizawa M, Yoshida S, Hara T. Intracranial Hypotension-associated Cerebral Swelling following Cranioplasty: Report of Two Cases. Asian J Neurosurg 2017; 12:794-796. [PMID: 29114315 PMCID: PMC5652127 DOI: 10.4103/1793-5482.185070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Cranioplasty is a comparatively simple neurosurgical procedure, and fatal complications are rare. This report describes two cases of critical brain swelling after otherwise uneventful cranioplasty. Both cases had subarachnoid hemorrhage and extremely similar clinical courses. They underwent decompressive craniotomy and clipping in the acute phase and had cranioplasty in the chronic phase, resulting in serious cerebral swelling and death. Deep venous sinus thrombosis was revealed in the autopsy for one case. Although no venous occlusion was identified in the other case, radiological findings suggested venous congestion. In both cases, intraoperative cerebrospinal fluid leakage was massive and was prolonged by a drain; therefore, we hypothesized that intracranial hypotension (IH) caused stagnation of venous flow. Neurosurgeons should be aware that fatal venous congestion induced by IH may occur after cranioplasty. To avoid this, tight dural closure should be obtained, and avoidance of the use of subcutaneous drains should be considered.
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Affiliation(s)
- Masashi Nomura
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Mitsugu Ishizawa
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takayuki Hara
- Department of Neurosurgery, Toranomon Hospital, Tokyo, Japan
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Wang W, Gao C, Yu C, Liu S, Hou D, Wang Y, Wang C, Mo L, Wu J. No Association between Elevated Total Homocysteine Levels and Functional Outcome in Elderly Patients with Acute Cerebral Infarction. Front Aging Neurosci 2017; 9:70. [PMID: 28377713 PMCID: PMC5359234 DOI: 10.3389/fnagi.2017.00070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background: An elevated plasma total homocysteine (tHcy) level is an independent risk factor for vascular events. The aim of the present study was to investigate the association between tHcy levels in the acute phase of cerebral infarction and functional outcome among elderly patients. Methods: Between October 2009 and December 2012, we recruited 594 elderly patients (age > 75) with first-onset acute cerebral infarction who were consecutively admitted to the Department of Neurology of Tianjin Huanhu Hospital, China. Levels of tHcy and other biochemical values were measured within 24 h after admission. tHcy values were classified according to quartiles (<9.94; 9.94 to <12.7; 12.7 to <16.8; and ≥16.8 μmol/L). We examined the relationship between tHcy levels at admission and modified Rankin Scale scores (mRS) using univariate and multivariate analyses. Patients were followed up at 3 months and 1 year after stroke. Results: Within 3 months after stroke, 64 patients died, 37 had recurrent ischemic stroke, and 22 were lost to follow-up; thus, 471 patients were reviewed and analyzed. By the time of the 1-year follow-up, an additional 48 patients had died, 44 had recurrent ischemic stroke, and 40 had been lost to follow-up; the remaining 339 patients were thus reviewed and analyzed. Elevated tHcy levels were not associated with functional outcome among elderly patients with acute cerebral infarction (p > 0.05). Only the National Institutes of Health Stroke Scale score was associated with a poor outcome after adjusting for confounders at 3 months and 1 year (adjusted odds ratio, 1.38; 95% CI, 1.28–1.49; p < 0.01; adjusted odds ratio, 1.34; 95% CI, 1.25–1.44; p < 0.01, respectively). Conclusion: Among elderly patients with acute cerebral infarction, elevated tHcy at admission was not a predictive factor of outcome at 3 months and 1 year after stroke onset.
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Affiliation(s)
- Wanjun Wang
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Chunlin Gao
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Changshen Yu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Shoufeng Liu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Dongzhe Hou
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Yajing Wang
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Chen Wang
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Lidong Mo
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
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Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke. Int J Mol Sci 2016; 17:ijms17121967. [PMID: 27898011 PMCID: PMC5187767 DOI: 10.3390/ijms17121967] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
After an acute ischemic stroke (AIS), inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs) released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.
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Abstract
AbstractBackground: Although D-dimer levels are significantly associated with cardioembolic infarction, the significance of D-dimer levels in relation to the severity and functional outcomes of other stroke subtypes, such as lacunar and large artery atherosclerosis infarction, remains unclear. The purpose of this study was to evaluate whether elevated initial D-dimer levels are significantly and cross-sectionally associated with poor functional outcomes at each time point during a 9-month follow-up period. We also investigated the significance of D-dimer levels in longitudinal temporal changes of functional outcomes in these patients. Methods: We recruited 146 patients with lacunar infarction and 161 patients with large artery atherosclerosis infarction who were consecutively admitted to our hospital after acute stroke. Serum D-dimer levels were evaluated initially and the modified Rankin scale were measured initially and at 1-, 3-, 6-, and 9-month follow-up visits. Results: Patients with higher D-dimer levels had significantly worse initial functional outcomes, and these worse outcomes were maintained throughout the 9-month follow-up period compared with the low D-dimer group. However, regardless of stroke subtype, D-dimer levels did not influence long-term changes in functional outcomes over the 9-month follow-up period. Conclusion: This study suggests that elevated D-dimer levels can be used as a surrogate marker for poor functional outcomes only during the acute stage. Further evaluation of serum D-dimer levels could provide a helpful predictive marker for stroke prognosis.
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Nickel CH, Kuster T, Keil C, Messmer AS, Geigy N, Bingisser R. Risk stratification using D-dimers in patients presenting to the emergency department with nonspecific complaints. Eur J Intern Med 2016; 31:20-4. [PMID: 27053291 DOI: 10.1016/j.ejim.2016.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with nonspecific complaints (NSC) such as generalized weakness present frequently to acute care settings. These patients are at risk of adverse health outcomes. The aim of our study was to test the hypothesis whether D-dimers are predictive for 30-day mortality in patients with NSCs. METHODS Delayed type cross-sectional diagnostic study with a 30-day follow-up period, registered with ClinicalTrials.gov (NCT00920491). This study took place in 2 EDs in Northwestern Switzerland. Patients were enrolled in the study if they were over 18years of age, gave informed consent, and if they presented with NSCs such as generalized weakness. D-dimer levels were determined at ED presentation. RESULTS The final study population consisted of 524 patients. Median age was 82years (IQR=75 to 87years); 40.5% were men. There were 489 survivors and 35 non-survivors at 30-day follow-up. Twenty-one (60%) of the non-survivors were males. D-dimer levels were significantly higher in non-survivors than in survivors (p<0.001). Univariate Cox regression models for D-dimer resulted in a C-index of 0.77 for prediction of mortality. A model including sex, age, Katz ADL and D-dimer in a multivariate Cox regression lead to a C-Index of 0.80. CONCLUSION D-dimer testing might be an effective risk stratification tool in patients with NSC by helping to identify patients at low risk of short-term mortality with a sensitivity of 0.97 and a negative likelihood ratio of 0.121. The use of D-dimers for risk stratification in patients with NSC should be confirmed with prospective studies.
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Affiliation(s)
- C H Nickel
- Emergency Department, University Hospital, Basel, Switzerland.
| | - T Kuster
- Emergency Department, University Hospital, Basel, Switzerland
| | - C Keil
- Emergency Department, University Hospital, Basel, Switzerland
| | - A S Messmer
- Emergency Department, University Hospital, Basel, Switzerland
| | - N Geigy
- Emergency Department, Kantonsspital Baselland, Liestal, Switzerland
| | - R Bingisser
- Emergency Department, University Hospital, Basel, Switzerland
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Gong P, Yang SH, Li S, Luo SH, Zeng RX, Zhang Y, Guo YL, Zhu CG, Xu RX, Li JJ. Plasma d-Dimer as a Useful Marker Predicts Severity of Atherosclerotic Lesion and Short-Term Outcome in Patients With Coronary Artery Disease. Clin Appl Thromb Hemost 2016; 22:633-40. [PMID: 26936933 DOI: 10.1177/1076029616634885] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increased d-dimer is indicative of a hypercoagulable state and found to be associated with acute coronary syndromes. The present study aimed to evaluate whether plasma d-dimer levels could predict subsequent major clinical events in patients with coronary artery disease (CAD). First, 2209 angiographic-proven patients with CAD were consecutively enrolled. Then, all patients were subjected to follow up for an average of 18 months (ranged from 14 to 1037 days). The relationships of the plasma d-dimer with the severity of CAD and future clinical outcomes were evaluated. We found that plasma d-dimer was higher in patients with prior myocardial infarction (MI) than that in patients with nonprior MI (P = .006). Multivariate linear regression analysis suggested that the plasma d-dimer was linked to the severity of CAD assessed by Gensini score (β = 0.052, 95% confidence interval [CI]: 1.20-6.84, P = .005) even after adjusting for confounding factors. During the follow-up, 42 patients underwent prespecified outcomes. After adjustment for multiple variables in the Cox regression model, the d-dimer levels remained to be a potential predictor of total outcome (hazard ratio = 1.22, 95% CI: 1.09-1.37, P = .001). Therefore, plasma d-dimer levels appeared to be a useful predictor for the severity of CAD and the subsequent major clinical events.
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Affiliation(s)
- Ping Gong
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China Department of Cardiology, The Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University, Wuhan, China
| | - Sheng-Hua Yang
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Sha Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Song-Hui Luo
- Department of Cardiology, The Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University, Wuhan, China
| | - Rui-Xiang Zeng
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Yan Zhang
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Yuan-Lin Guo
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Cheng-Gang Zhu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Rui-Xia Xu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Jian-Jun Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
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Abd-Elhamid Y, Tork M, Abdulghani M. Prognostic value of D-dimer measurement in patients with acute ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2016. [DOI: 10.4103/1110-1083.193090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Marques SM, Santos A, Gonçalves LM, Sousa JC, Bueno PR. Sensitive label-free electron chemical capacitive signal transduction for D-dimer electroanalysis. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2015.09.169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Huang B, Yang Y, Lu H, Zhao Z, Zhang S, Hui R, Fan X. Impact of d-Dimer Levels on Admission on Inhospital and Long-Term Outcome in Patients With Type A Acute Aortic Dissection. Am J Cardiol 2015; 115:1595-600. [PMID: 25863830 DOI: 10.1016/j.amjcard.2015.02.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 01/16/2023]
Abstract
Limited studies with relatively small sample sizes have reported that elevated d-dimer levels on admission were associated with increased risk of short-term mortality in patients with type A acute aortic dissection (AAD). However, there were unavailable data regarding the impact of admission d-dimer levels on long-term outcomes. Our present study aimed to evaluate the association of admission d-dimer levels with both inhospital and long-term all-cause mortality in patients with type A AAD. A total of 212 consecutive patients with type A AAD were enrolled. d-Dimer levels were measured on admission, and patients were followed up prospectively. The primary end points were inhospital and long-term all-cause mortality. The median length of follow-up was 18.8 months (interquartile range 6.7 to 24.4 months). The inhospital and long-term all-cause mortality rates were 12.7% and 12.4%, respectively. Compared with the survivors, the nonsurvivors had significantly higher d-dimer levels (p <0.001). When divided into 4 groups according to admission d-dimer quartiles, patients in Q4 (>6.10 μg/ml) had the highest inhospital and long-term mortality among groups. After multivariate adjustment, the d-dimer level in Q4 (>6.10 μg/ml) was an independent risk factor for inhospital mortality (hazard ratio [HR] 6.12, 95% confidence interval 1.35 to 27.89, p = 0.019) in addition to surgical treatment; however, this was not an independent predictor for long-term mortality. In conclusion, our study with a relatively large sample size suggested that elevated admission d-dimer levels (>6.10 μg/ml) might be a predictor for increased risk of inhospital mortality, and urgent-emergent surgery might be needed in patients with elevated d-dimer levels on admission. However, d-dimer levels at admission failed to predict long-term mortality.
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Affiliation(s)
- Bi Huang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanmin Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haisong Lu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenhua Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Bustamante A, Garcia-Berrocoso T, Llombart V, Simats A, Giralt D, Montaner J. Neuroendocrine hormones as prognostic biomarkers in the setting of acute stroke: overcoming the major hurdles. Expert Rev Neurother 2014; 14:1391-403. [PMID: 25418815 DOI: 10.1586/14737175.2014.977867] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke represents one of the major causes of disability and mortality worldwide and prediction of outcome represents a challenge for both clinicians and researchers. In the past years, many blood markers have been associated with stroke outcome but despite this evidence, no biomarker is routinely used in stroke management. In this review, we focus on markers of the neuroendocrine system, which represent potential candidates to be implemented in clinical practice. Moreover, we present a systematic review and literature-based meta-analysis for copeptin, a new biomarker of the hypothalamo-pituitary-adrenal axis that has shown additional predictive value over clinical information in a large prospective study. The meta-analysis of the included 7 studies, with more than 2000 patients, reinforced its association with poor outcome (pooled odds ratio: 2.474 [1.678-3.268]) and mortality (pooled OR: 2.569 [1.642-3.495]). We further review the current situation of the topic and next steps to implement these tools by clinicians.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institut of Research, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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Xia XH, Huang D. Combined detection of serum follistain-like protein 1, C-reactive protein and D-dimer for early diagnosis of ulcerative colitis. Shijie Huaren Xiaohua Zazhi 2014; 22:1628-1632. [DOI: 10.11569/wcjd.v22.i11.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the significance of joint detection of blood follistain-like protein 1 (FSTL1), C-reactive protein (CRP) and D-dimer in the early diagnosis of ulcerative colitis.
METHODS: Venous blood samples were collected from 67 patients with ulcerative colitis and 60 healthy people. Serum levels of FSTL1, CRP and D-dimer were detected by ELISA, and the significance of combined detection of the three indexes in the early diagnosis of ulcerative colitis was analyzed.
RESULTS: Serum levels of FSTL1, CRP and D-two dimer were significantly higher in UC patients than in normal controls, and in patients with active UC than in those in remission (t = 10.671, 10.398, 31.873, P < 0.05 for all). With the aggravation of the disease, serum levels of FSTL1, CRP and D-dimer significantly increased in patients with UC, and the levels were significantly higher in the severe group than in the moderate and mild groups (t = 5. 766, 5.821, 2.307, 2.213, 2.789, 2.363, P < 0.05 for all). Serum levels of FSTL1, CRP, and D-dimer were significantly correlated with UC disease activity index (DAI) (r = 0.511, 0.312, 0.317, P < 0.05 for all). The sensitivity and negative predictive value of combined detection of FSTL1, CRP and D-dimer were significantly higher than those of detection of any one of the indexes (χ2 = 0.013, 4. 823, P < 0.05).
CONCLUSION: The joint detection of serum FSTL1, CRP and D-dimer can be used for early diagnosis of ulcerative colitis.
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