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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/30937


    標題: Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage
    作者: Chen, Chih-Wei
    Wu, En-Hsuan
    Huang, Judy
    Chang, Wen-Tsan
    Ao, Kam-Hou
    Cheng, Tain-Junn
    Yang, Wuyang
    貢獻者: Chi Mei Med Ctr, Dept Surg, Div Neurosurg
    Natl Cheng Kung Univ
    Chia Nan Univ Pharm & Sci, Coll Sustainable Environm, Inst Ind Safety & Disaster Prevent, Dept Occupat Safety & Hlth
    China Med Univ Hosp, Dept Phys Med & Rehabil
    Johns Hopkins Univ, Johns Hopkins Hosp, Sch Med, Dept Neurosurg
    Natl Cheng Kung Univ, Coll Med, Dept Biochem & Mol Biol
    Chi Mei Med Ctr, Dept Neurol & Occupat Med
    關鍵字: CSF
    D-dimer
    Intracerebral hemorrhage
    Intraventricular hemorrhage
    日期: 2016-07
    上傳時間: 2018-01-18 11:38:17 (UTC+8)
    出版者: Elsevier Sci Ltd
    摘要: The risk of mortality in patients with intracerebral hemorrhage (ICH) significantly increases when complicated by intraventricular hemorrhage (IVH). We hypothesize that serial measurement of cerebrospinal fluid (CSF) D-dimer levels in patients with both ICH and IVH may serve as an early marker of IVH severity. We performed a prospective study of 43 consecutive ICH patients combined with IVH and external ventricular drainage placement admitted in our institution from 2005-2006. IVH severity (Graeb score) and fibrinolytic activity were evaluated continuously for 7 days using CT scans and CSF D-dimer levels. The primary outcome was 30 day mortality. Overall 30 day mortality was 26% (n =11), with eight deaths (72.7%) after 3 days (D3). Graeb score and CSF D-dimer on admission (DO) were not significantly different between survivors and non-survivors. The temporal profiles of both parameters were distinctly different, with a downward trend in survivors and an upward trend in non-survivors. A mortality rate of 54% was observed between D0-D3 when both scores increased during this interval. In contrast, the mortality was only 4% when both measures decreased during this interval. Early phase (D0-D3) CSF D-dimer or Graeb score change demonstrated high sensitivity of 88% and specificity of 81% when predicting 30 day mortality. Early phase CSF D-dimer change in patients with both ICH and IVH is accurate in predicting mortality and may be utilized as a cost-effective surrogate indicator of IVH severity. Serial monitoring of CSF D-dimer dynamic changes is useful for early identification of patients with hematoma progression and poor outcome. (c) 2015 Elsevier Ltd. All rights reserved.
    關聯: Journal of Clinical Neuroscience, v.29, pp.149-154
    Appears in Collections:[職業安全衛生系(含防災所)] 期刊論文

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