title: Plasma D-dimer may predict poor functional outcomes through systemic complications after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE Plasma D-dimer levels elevate during acute stages of aneurysmal subarachnoid hemorrhage (SAH) and are associated with poor functional outcomes. However, the mechanism in which D-dimer elevation on admission affects functional outcomes remains unknown. The aim of this study is to clarify whether D-dimer levels on admission are correlated with systemic complications after aneurysmal SAH, and to investigate their additive predictive value on conventional risk factors for poor functional outcomes. METHODS A total of 187 patients with aneurysmal SAH were retrospectively analyzed from a single-center, observational cohort database. Correlations of plasma D-dimer levels on admission with patient characteristics, initial presentation, neurological complications, and systemic complications were identified. The authors also evaluated the additive value of D-dimer elevation on admission for poor functional outcomes by comparing predictive models with and without D-dimer. RESULTS D-dimer elevation on admission was associated with increasing age, female sex, and severity of SAH. Patients with higher D-dimer levels had increased likelihood of nosocomial infections (OR 1.22 [95% CI 1.07-1.39], p = 0.004), serum sodium disorders (OR 1.11 [95% CI 1.01-1.23], p = 0.033), and cardiopulmonary complications (OR 1.20 [95% CI 1.04-1.37], p = 0.01) on multivariable analysis. D-dimer elevation was an independent risk factor of poor functional outcome (modified Rankin Scale Score 3-6, OR 1.50 [95% CI 1.15-1.95], p = 0.003). A novel prediction model with D-dimer had significantly better discrimination ability for poor outcomes than conventional models without D-dimer. CONCLUSIONS Elevated D-dimer levels on admission were independently correlated with systemic complication, and had an additive value for outcome prediction on conventional risk factors after aneurysmal SAH.
authors: Departments of 1 Neurosurgery.|Interventional Neuroradiology, and.
authors: Hitoshi
authors: H
authors: Fukuda
authors: Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors: Benjamin
authors: B
authors: Lo
authors: Departments of 1 Neurosurgery.
authors: Yu
authors: Y
authors: Yamamoto
authors: Interventional Neuroradiology, and.
authors: Akira
authors: A
authors: Handa
authors: Clinical Research, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; and.
authors: Yoshiharu
authors: Y
authors: Yamamoto
authors: Departments of 1 Neurosurgery.
authors: Yoshitaka
authors: Y
authors: Kurosaki
authors: Departments of 1 Neurosurgery.
authors: Sen
authors: S
authors: Yamagata
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications / Q000503:physiopathology*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; DCI = delayed cerebral infarction; DIND = delayed ischemic neurological deficit; ICH = intracerebral hemorrhage; IDI = integrated discrimination improvement; IVH = intraventricular hemorrhage; NRI = net reclassification improvement; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies; functional outcome; mRS = modified Rankin Scale; subarachnoid hemorrhage; systemic complications; vascular disorders