Plasma D-dimer predicts poor outcome after acute intracerebral hemorrhage
Plasma D-dimer predicts poor outcome after acute intracerebral hemorrhage
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DOI：
10.1212/01.wnl.0000223349.97278.e0
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发表时间：
2006-07-11
期刊：
影响因子：
9.9
通讯作者：
Montaner, J.
中科院分区：
文献类型：
--
作者：
Delgado, P.;Alvarez-Sabin, J.;Montaner, J.
目的：探讨急性脑出血（ICH）后是否发生全身性d -二聚体活化，并探讨其对临床预后的影响。方法：测定98例连续急性（< 24小时）脑出血患者血浆基线d -二聚体。记录格拉斯哥昏迷量表和NIH卒中量表评分，以评估基线和随访时（24小时、48小时、第7天和第3个月）的神经系统状态。他们还在21名患者的随访中测定了d -二聚体的时间谱。在基线和随访CT扫描中测量脑出血体积。记录第1周的早期神经功能恶化（END）和死亡率。结果：脑出血患者血浆d -二聚体水平在基线时（1780 vs 360 ng/mL, p = 0.013）和脑出血发病3个月后（1530 vs 470 ng/mL, p = 0.013）均高于实验室参考值。d -二聚体水平与基线ICH体积（r = 0.23, p = 0.049）和脑室内（2370 vs 1360 ng/ mL, p = 0.019）或蛛网膜下腔（4180 vs 1520 ng/ mL, p = 0.001）扩张有关。近四分之一的患者出现了END， 20%的患者死于ICH。作为END的预测因子，作者确定d -二聚体水平> 1,900 ng/ mL（比值比[OR] 4.5, 95% CI 1.03 ~ 20.26, p = 0.045）和收缩压> 182 mm Hg（比值比[OR] 6.8, 95% CI 1.25 ~ 36.9, p = 0.026）。此外，脑出血体积> 30 mL （OR 19.13, 95% CI 2.06 ~ 177, p = 0.009）和d -二聚体水平> 1,900 ng/ mL （OR 8.75, 95% CI 1.41 ~ 54.16, p = 0.020）成为死亡率的独立预测因子。结论：急性脑出血后血浆d -二聚体水平升高与早期神经功能恶化及预后不良有关。
Objective: To investigate if systemic D-dimer activation occurs after acute intracerebral hemorrhage (ICH) and to study its influence on clinical outcome. Methods: The authors determined plasma baseline D-dimer in 98 consecutive acute (< 24 hours) ICH patients. Glasgow Coma Scale and NIH Stroke Scale scores were recorded to assess neurologic status on baseline and follow-up visits (24 hours, 48 hours, 7th day, and 3rd month). They also determined the D-dimer temporal profile at follow-up visits in a subgroup of 21 patients. ICH volume was measured on baseline and follow-up CT scans. Early neurologic deterioration (END) and mortality during the 1st week were recorded. Results: ICH patients showed higher plasma D-dimer level than reference laboratory values at baseline (1,780 vs 360 ng/mL; p = 0.013) and 3 months after ICH onset (1,530 vs 470 ng/ mL; p = 0.013). The D-dimer level was related to baseline ICH volume (r = 0.23, p = 0.049) and to the presence of intraventricular (2,370 vs 1,360 ng/ mL; p = 0.019) or subarachnoid (4,180 vs 1,520 ng/ mL; p = 0.001) extension. Nearly one-fourth of patients presented END, and 20% died as a result of ICH. As predictors of END, the authors identified D-dimer level > 1,900 ng/ mL (odds ratio [OR] 4.5, 95% CI 1.03 to 20.26, p = 0.045) and systolic blood pressure > 182 mm Hg (OR 6.8, 95% CI 1.25 to 36.9, p = 0.026). Moreover, ICH volume > 30 mL (OR 19.13, 95% CI 2.06 to 177, p = 0.009) and D-dimer levels > 1,900 ng/ mL (OR 8.75, 95% CI 1.41 to 54.16, p = 0.020) emerged as independent predictors of mortality. Conclusion: Increased plasma D-dimer level following acute intracerebral hemorrhage is associated with early neurologic deterioration and poor outcome.