Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage

doi:10.1016/j.jocn.2015.10.036

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Title:	Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage
Authors:	Chen, Chih-Wei Wu, En-Hsuan Huang, Judy Chang, Wen-Tsan Ao, Kam-Hou Cheng, Tain-Junn Yang, Wuyang
Contributors:	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
Keywords:	CSF D-dimer Intracerebral hemorrhage Intraventricular hemorrhage
Date:	2016-07
Issue Date:	2018-01-18 11:38:17 (UTC+8)
Publisher:	Elsevier Sci Ltd
Abstract:	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.
Relation:	Journal of Clinical Neuroscience, v.29, pp.149-154
Appears in Collections:	[Dept. of Occupational Safety] Periodical Articles

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