title: D-dimer as a predictor of progressive hemorrhagic injury in patients with traumatic brain injury: analysis of 194 cases.
abstract: This study sought to describe and evaluate any relationship between D-dimer values and progressive hemorrhagic injury (PHI) after traumatic brain injury (TBI). In patients with TBI, plasma D-dimer was measured while a computed tomography (CT) scan was conducted as soon as the patient was admitted to the emergency department. A series of other clinical and laboratory parameters were also measured and recorded. A logistic multiple regression analysis was used to identify risk factors for PHI. A cohort of 194 patients with TBI was evaluated in this clinical study. Eighty-one (41.8%) patients suffered PHI as determined by a second CT scan. The plasma D-dimer level was higher in patients who demonstrated PHI compared with those who did not (P < 0.001. Using a receiver-operator characteristic curve to predict the possibility by measuring the D-dimer level, a value of 5.00 mg/L was considered the cutoff point, with a sensitivity of 72.8% and a specificity of 78.8%. Eight-four patients had D-dimer levels higher than the cut point value (5.0 mg/L); PHI was seen in 71.4% of these patients and in 19.1% of the other patients (P < 0.01). Factors with P < 0.2 on bivariate analysis were included in a stepwise logistic regression analysis to identify independent risk factors for TBI coagulopathy. Logistic regression analysis showed that the D-dimer value was a predictor of PHI, and the odds ratio (OR) was 1.341 with per milligram per liter (P = 0.020). The stepwise logistic regression also identified that time from injury to the first CT shorter than 2 h (OR = 2.118, P = 0.047), PLT counts lesser than 100 x 109/L (OR = 7.853, P = 0.018), and Fg lower than 2.0 g/L (OR = 3.001, P = 0.012) were risk factors for the development of PHI. When D-dimer values were dichotomized at 5 mg/L, time from injury to the first CT scan was no longer a risk factor statistically while the OR value of D-dimer to the occurrence of PHI elevated to 11.850(P < 0.001). The level of plasma D-dimer after TBI can be a useful prognostic factor for PHI and should be considered in the clinical management of patients in combination with neuroimaging and other data.
authors.affiliation: Department of Neurosurgery, Shanghai 6th People Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, Xuhui District, Shanghai, China 200233.
authors.forename: Heng-Li
authors.initials: HL
authors.lastname: Tian
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Bing-Shan
authors.initials: BS
authors.lastname: Wu
authors.forename: He-Li
authors.initials: HL
authors.lastname: Cao
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.forename: Jin
authors.initials: J
authors.lastname: Hu
authors.forename: Gan
authors.initials: G
authors.lastname: Wang
authors.forename: Wen-Wei
authors.initials: WW
authors.lastname: Gao
authors.forename: Zai-Kai
authors.initials: ZK
authors.lastname: Lin
authors.forename: Shi-Wen
authors.initials: SW
authors.lastname: Chen
mesh_terms: D000328:Adult; D015415:Biomarkers; D001777:Blood Coagulation; D020202:Cerebral Hemorrhage, Traumatic / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D015600:Glasgow Coma Scale; D006474:Hemorrhagic Disorders / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D