title: Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage.
abstract: The risk of mortality in patients with intracerebral hemorrhage (ICH) significantly increases when complicated by intraventricular hemorrhage (IVH). We hypothesize that serial measurement of cerebrospinal fluid (CSF) D-dimer levels in patients with both ICH and IVH may serve as an early marker of IVH severity. We performed a prospective study of 43 consecutive ICH patients combined with IVH and external ventricular drainage placement admitted in our institution from 2005-2006. IVH severity (Graeb score) and fibrinolytic activity were evaluated continuously for 7days using CT scans and CSF D-dimer levels. The primary outcome was 30day mortality. Overall 30day mortality was 26% (n=11), with eight deaths (72.7%) after 3days (D3). Graeb score and CSF D-dimer on admission (D0) were not significantly different between survivors and non-survivors. The temporal profiles of both parameters were distinctly different, with a downward trend in survivors and an upward trend in non-survivors. A mortality rate of 54% was observed between D0-D3 when both scores increased during this interval. In contrast, the mortality was only 4% when both measures decreased during this interval. Early phase (D0-D3) CSF D-dimer or Graeb score change demonstrated high sensitivity of 88% and specificity of 81% when predicting 30day mortality. Early phase CSF D-dimer change in patients with both ICH and IVH is accurate in predicting mortality and may be utilized as a cost-effective surrogate indicator of IVH severity. Serial monitoring of CSF D-dimer dynamic changes is useful for early identification of patients with hematoma progression and poor outcome.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
authors.forename: En-Hsuan
authors.initials: EH
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, School of Medicine, Johns Hopkins University, 6128 Zayed Tower, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21218, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.affiliation: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan; Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Taiwan.
authors.forename: Wen-Tsan
authors.initials: WT
authors.lastname: Chang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Taiwan.
authors.forename: Kam-Hou
authors.initials: KH
authors.lastname: Ao
authors.affiliation: Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Taiwan; Department of Neurology and Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Tain-Junn
authors.initials: TJ
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, School of Medicine, Johns Hopkins University, 6128 Zayed Tower, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21218, USA. Electronic address: wyang19@jhmi.edu.
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002552:Cerebral Ventricles; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000134:cerebrospinal fluid*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: CSF; D-dimer; Intracerebral hemorrhage; Intraventricular hemorrhage