Plasma D-dimer may predict poor functional outcomes through systemic complications after aneurysmal subarachnoid hemorrhage

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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.

ABBREVIATIONS DCI = delayed cerebral infarction; DIND = delayed ischemic neurological deficit; ICH = intracerebral hemorrhage; IDI = integrated discrimination improvement; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; NRI = net reclassification improvement; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies.
Article Information

Contributor Notes

Correspondence Hitoshi Fukuda, Department of Neurosurgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki City, Okayama 710-0052, Japan. email: fukudaharpseal@gmail.com.INCLUDE WHEN CITING Published online August 12, 2016; DOI: 10.3171/2016.5.JNS16767.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© Copyright 1944-2019 American Association of Neurological Surgeons

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