Association between D-dimer levels and long-term mortality in patients with aneurysmal subarachnoid hemorrhage.

OBJECTIVE D-dimer is a marker for hypercoagulability and thrombotic events. The authors sought to investigate whether D-dimer levels predicted long-term mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS This was a retrospective study of patients with aSAH in West China Hospital, Sichuan University, between December 2013 and June 2019. D-dimer levels were measured within 24 hours after admission and were grouped by quartiles. The primary outcome was long-term mortality. Patient deaths were determined through the Household Registration Administration System in China, with a median of 4.4 years of follow-up. RESULTS This study included 2056 patients. Compared with patients with the lowest quartile (0.00-0.97 mg/L) of D-dimer levels, the odds of long-term mortality were significantly higher in all other patients, including those with D-dimer levels between 0.97 mg/L and 1.94 mg/L (adjusted hazard ratio [aHR] 1.85, 95% CI 1.32-2.60), those with D-dimer levels between 1.94 mg/L and 4.18 mg/L (aHR 1.94, 95% CI 1.40-2.70), and those patients with the highest quartile (> 4.18 mg/L) of D-dimer levels (aHR 2.35, 95% CI 1.70-3.24; p < 0.001). Similar results were observed for the endpoints of 1-year mortality and long-term mortality in 1-year survivors. CONCLUSIONS Elevated D-dimer levels at admission were associated with short-term and long-term mortality. This biomarker could be considered in future risk nomograms for long-term outcomes and might support future management decisions.

[1]  P. Heuschmann,et al.  Role of Blood-Based Biomarkers in Ischemic Stroke Prognosis: A Systematic Review. , 2021, Stroke.

[2]  F. Ebner,et al.  Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage - Serum D-dimer and C-reactive Protein as Early Markers. , 2019, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[3]  Ann M. Stowe,et al.  Biomarker Application for Precision Medicine in Stroke , 2019, Translational Stroke Research.

[4]  P. Palczewski,et al.  D-dimer levels enhance the discriminatory capacity of bleeding risk scores for predicting in-hospital bleeding events in acute pulmonary embolism. , 2019, European journal of internal medicine.

[5]  M. Toyofuku,et al.  D-dimer levels at diagnosis and long-term clinical outcomes in venous thromboembolism: from the COMMAND VTE Registry , 2019, Journal of Thrombosis and Thrombolysis.

[6]  R. D'Agostino,et al.  New Guidelines for Statistical Reporting in the Journal. , 2019, The New England journal of medicine.

[7]  A. Keech,et al.  D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease: LIPID Study , 2018, Circulation.

[8]  J. Eikelboom,et al.  A Test in Context: D-Dimer. , 2017, Journal of the American College of Cardiology.

[9]  Takayuki Otani,et al.  D‐dimer predicts bleeding complication in out‐of‐hospital cardiac arrest resuscitated with ECMO , 2017, The American journal of emergency medicine.

[10]  Yoshiharu Yamamoto,et al.  Plasma D-dimer may predict poor functional outcomes through systemic complications after aneurysmal subarachnoid hemorrhage. , 2017, Journal of neurosurgery.

[11]  Kijeong Lee,et al.  D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale , 2015, Thrombosis and Haemostasis.

[12]  M. Lehecka,et al.  Long-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage: Patients With Multiple Aneurysms at Risk , 2015, Stroke.

[13]  E. Hylek,et al.  D‐dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation – observations from the ARISTOTLE trial , 2014, Journal of thrombosis and haemostasis : JTH.

[14]  P. Vineis,et al.  Elevated levels of D-dimers increase the risk of ischaemic and haemorrhagic stroke , 2014, Thrombosis and Haemostasis.

[15]  J. Jansson,et al.  D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. , 2014, Clinical biochemistry.

[16]  A. Kılıçgedik,et al.  The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction , 2014, Journal of Thrombosis and Thrombolysis.

[17]  Paul Vespa,et al.  Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2012, Stroke.

[18]  A. Algra,et al.  Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage , 2011, The Lancet Neurology.

[19]  O. Hugli Letter by Hugli regarding article, "Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience". , 2010, Circulation.

[20]  Ale Algra,et al.  Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis , 2009, The Lancet Neurology.

[21]  Soheir S Adam,et al.  D-dimer antigen: current concepts and future prospects. , 2009, Blood.

[22]  Jan Claassen,et al.  Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. , 2006, Neurosurgery.

[23]  S. Juvela,et al.  d-Dimer as an Independent Predictor for Poor Outcome After Aneurysmal Subarachnoid Hemorrhage , 2006, Stroke.

[24]  S. Juvela,et al.  D-dimer Predicts Outcome after Aneurysmal Subarachnoid Hemorrhage: No Effect of Thromboprophylaxis on Coagulation Activity , 2005, Neurosurgery.

[25]  M. Kaste,et al.  Hemostasis and fibrinolysis activation after subarachnoid hemorrhage. , 1997, Journal of neurosurgery.

[26]  S. Basili,et al.  Association between High Values of D-dimer and Tissue-plasminogen Activator Activity and First Gastrointestinal Bleeding in Cirrhotic Patients , 1996, Thrombosis and Haemostasis.

[27]  Y. Fujii,et al.  Hemostasis in spontaneous subarachnoid hemorrhage. , 1995, Neurosurgery.

[28]  M. Wood,et al.  Analysis and interpretation of data. , 1978, The Journal of family practice.

[29]  C. Symonds,et al.  Spontaneous Sub-Arachnoid Hæmorrhage , 1924, Proceedings of the Royal Society of Medicine.