D-dimer as an independent predictor for poor outcome after aneurysmal subarachnoid hemorrhage
D-dimer as an independent predictor for poor outcome after aneurysmal subarachnoid hemorrhage
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DOI：
10.1161/01.str.0000221710.55467.33
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发表时间：
2006-06-01
期刊：
影响因子：
8.3
通讯作者：
Siironen, J
中科院分区：
文献类型：
--
作者：
Juvela, S;Siironen, J
背景和目的：蛛网膜下腔出血（SAH）后，D-二聚体水平升高与不良临床状况和预后相关。我们前瞻性地测试了D-二聚体值是否会影响SAH后的结局，而与出血的严重程度无关。方法-记录了136名出血后48小时内入院的SAH患者的既往疾病、临床和放射学变量。在动脉瘤闭塞后的早晨和SAH后10至12天的出院时测定血浆D-二聚体。根据SAH后3个月的格拉斯哥结局量表预测不良结局的因素和脑梗死的出现用多元logistic回归进行了测试。结果-结局不良的患者比结局良好的患者有更高的D-二聚体值：手术后，中位数1250（第25和第75百分位数675和2900）μ g/L与720（350和1119）μ g/L（P = 0.001）;出院时分别为1150（624和2875）μ g/L和360（330和600）μ g/L（P < 0.001）。在重复测量方差分析中，D-二聚体下降更快（P = 0.022），在那些有良好的结果。在同时校正了影响预后的几个因素后，术后血浆D-二聚体仍然是预后不良的重要预测因子（比值比，1.63/mg/L; 95% CI，1.03 - 2.60; P = 0.038），但对于延迟性缺血，结论：入院后血浆D-二聚体水平升高独立预测预后不良，提示凝血酶生成时间过长可能损害预后。重复的高血浆D-二聚体值可用于发现不良结局风险增加的患者。
Background and Purpose - After aneurysmal subarachnoid hemorrhage ( SAH), elevated D-dimer levels have been associated with poor clinical condition and outcome. We tested prospectively whether D-dimer values affect outcome after SAH independently of severity of bleeding.Methods - Previous diseases, and clinical as well as radiological variables, were recorded for 136 patients with SAH admitted within 48 hours after bleeding. Plasma D-dimer was measured in the morning after aneurysm occlusion and at discharge 10 to 12 days after SAH. Factors predicting poor outcome according to the Glasgow Outcome Scale at 3 months after SAH and appearance of cerebral infarction were tested with multiple logistic regression.Results - Patients with poor outcome had higher D-dimer values than did those with favorable outcome: after surgery, a median 1250 ( 25th and 75th percentiles 675 and 2900) mu g/L versus 720 ( 350 and 1119) mu g/L ( P = 0.001); and at discharge, 1150 ( 624 and 2875) mu g/L versus 360 ( 330 and 600) mu g/L ( P < 0.001), respectively. In repeated-measures ANOVA, D-dimer decreased more rapidly ( P = 0.022) in those with favorable outcome. After simultaneous adjustment for several factors affecting outcome, plasma D-dimer after surgery remained a significant predictor for poor outcome ( odds ratio, 1.63 per mg/L; 95% CI, 1.03 to 2.60; P = 0.038) but neither for delayed ischemia nor, on follow-up computed tomography in survivors, for cerebral infarction.Conclusions - Elevated plasma D-dimer after admission independently predicts poor outcome, suggesting that prolonged excess thrombin generation may impair outcome. Repeated high plasma D-dimer values can be useful in discovering patients at increased risk for poor outcome.