动脉瘤性蛛网膜下腔出血血管内栓塞后D—dimer浓度变化与预后的关系

目的探讨动脉瘤性蛛网膜下腔出血（SAH）血管内栓塞后D-dimer浓度的变化以及D-dimer浓度升高能否做为预后不良的独立预测因素。方法对204例发病48h内人住我院和郑州大学第二附属医院神经内科的SAH病人,在手术当天早晨和动脉瘤填塞后14d检测血浆D-dimer浓度,3个月时根据格拉斯哥预后评分和CT随访脑梗塞的发生做为预后不良的预测因素。结果动脉瘤栓塞后预后不良的病人较预后良好者D—dimer浓度明显升高,手术当天2组各自平均为（1368±298）μg／L和（756土144）／xg／L,14d时分别为（1129±166）μg／I,和（356±73）μg／L,P〈O．001。重复检测发现,预后良好者D-climer浓度降低较快,排除其他影响因素后,D-dimer与预后不良有明显关系。结论SAH后血浆D-dimer升高是预后不良的独立预测因素,可能与凝血酶代谢产物过量积聚引起的损害有关。     

血浆D-二聚体水平与急性脑梗死患者预后的关系

目的探讨血浆D-二聚体水平与急性脑梗死患者预后的关系。方法采用乳胶免疫比浊法检测673例急性脑梗死患者血浆D-二聚体的含量。并于发病30 d时对患者进行改良Rankin量表评分,评定预后。对不同预后患者的结果进行比较分析。结果发病30 d时,mRS评分0~2分(预后良好组)342例;mRS评分3~6分(预后不良组)331例。预后不良组患者血浆D-二聚体水平[(386.56±31.22)μg/L]明显高于预后良好组[(379.84±33.71)μg/L](P0.01)。Logistic回归分析显示,血浆D-二聚体水平升高是急性脑梗死患者预后不良的独立危险因素(OR=2.423,95%CI:1.537~3.862,P0.05)。结论血浆D-二聚体水平升高是急性脑梗死患者预后不良的独立危险因素。     

急性高血压脑出血患者血浆CXCL12水平与脑水肿的相关性研究

目的探讨急性高血压脑出血患者血浆CXCL12水平的动态变化及其对预后的影响,以及血浆CXCL12水平与相对水肿体积的关系。方法选择急性高血压脑出血患者34例,于发病24小时内、第3天、第7天和第14天采用ELISA法检测血浆CXCL12水平,选择同期25例健康体检者作为对照组。根据mRS评分将脑出血患者分为预后良好组(mRS≤2分)和预后不良组(mRS2分)。于发病24小时内、第3天和第7天根据颅脑CT计算相对水肿体积。结果脑出血组24小时内血浆CXCL12水平(19.85±1.84)μg/L明显高于对照组(11.34±2.23)μg/L,P0.01。脑出血组血浆CXCL12水平在第3天时快速上升(22.56±1.56)μg/L,在第7天达高峰(23.38±1.53)μg/L,在第14天时下降(22.64±1.78)μg/L。预后良好组与整体的变化趋势一致,预后不良组血浆CXCL12水平在第14天时未见下降;两组血浆CXCL12水平在第7天时和第14天时比较差异均有统计学意义,P值分别为0.05和0.01。Pearson相关性分析显示第3天和第7天血浆CXCL12水平与相对水肿体积呈正相关,相关系数分别为(r=0.631,P0.01)和(r=0.435,P0.05)。结论血浆CXCL12水平在脑出血后明显升高,持续性CXCL12水平升高的患者预后较差。动态检测血浆CXCL12水平能够为脑水肿的评估和治疗提供依据。     

急性脑梗死患者血浆CXCL12水平的改变及其对预后的影响

目的探讨急性脑梗死患者血浆CXCL12水平的改变及其对预后的影响。方法采用ELISA法检测185例急性脑梗死患者(脑梗死组)及123例正常体检者(对照组)的血浆CXCL12水平。对脑梗死患者进行NIHSS评分及mRS评分,采用Pearson相关性分析法分析脑梗死组患者血浆CXCL12水平与NIHSS评分的相关性。根据mRS评分,将脑梗死组患者分为预后良好亚组(mRS评分0~2分)和预后不良亚组(mRS评分3~6分),比较两亚组患者的血浆CXCL12水平,并进行Logistic回归分析。结果脑梗死组患者血浆CXCL12水平[(3.75±1.40)μg/ml]明显高于对照组[(0.96±0.67)μg/ml](P0.01)。Pearson相关性分析显示,脑梗死组患者血浆CXCL12水平与入院时NIHSS评分呈负相关(r=-0.857,P0.01)。预后良好亚组患者血浆CXCL12水平[(4.56±1.24)μg/ml]明显高于预后不良组[(2.75±0.84)μg/ml](P0.01)。Logistic回归分析结果显示,血浆CXCL12水平升高是预后不良的独立保护因素(OR=0.416,95%CI:0.225~0.768,P=0.005)。结论急性脑梗死患者的血浆CXCL12水平升高,是其预后不良的独立保护因素。血浆CXCL12水平可作为评价急性脑梗死预后的一个重要的生物学指标。     

血浆S100B蛋白预测动脉瘤性蛛网膜下腔出血短期预后及并发症的研究

目的测定动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者急性期血浆中S100B蛋白水平,评价其对该病短期临床预后及并发症的预测价值。方法连续入组天坛医院1年内发病72h内a SAH患者以及正常健康对照。采集患者临床信息,留取患者及对照组血样标本,通过ELISA法测定其血浆中S100B蛋白水平,分析其对a SAH患者短期预后不良和院内并发症的预测价值。结果纳入符合标准的患者118例,健康对照组130例,与对照组相比a SAH急性期血浆S100B水平升高(28.55 pg/m L vs.21.20 pg/m L,P0.001)。入院时Hunt-Hess分级3~5级(P0.001)、住院期间发生迟发型脑缺血(P0.001)、血浆S100B蛋白水平增高(P=0.05)以及脑积水(P=0.028)的患者预后不良风险明显增高。血浆S100B蛋白水平高的患者院内并发症风险增加(P=0.049)。结论急性期血浆S100B蛋白增高可预测a SAH短期功能预后不良以及院内并发症的发生。     

C-反应蛋白与动脉瘤性蛛网膜下腔出血临床预后的关系

目的探讨动脉瘤性蛛网膜下腔出血(a SAH)血清C-反应蛋白(CRP)动态变化趋势及其与临床预后的关系。方法2014年1月至2015年8月前瞻性收集符合标准的a SAH 108例,发病72 h内行夹闭术(72例)或血管内栓塞(36例)。术后3个月采用GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。入院时、术后1、3、5、7 d及出院当天,采集清晨空腹静脉血,检测血清CRP水平。采用多因素Logistic回归分析检验预后不良危险因素。结果 108例中,预后良好68例,预后不良40例。多因素Logistic回归分析显示,术后1、3 d血清CRP水平增高是a SAH不良预后的独立危险因素。受试者工作特征曲线分析结果术后3 d血清CRP水平[曲线下面积(AUC)=0.823]与术后1 d(AUC=0.861)相比,对不良预后的发生具有更好的预测价值。术后1 d血清CRP与入院时GCS评分、入院时Fisher评分和入院时Hunt-Hess分级均无明显相关性(P0.05)。术后3 d血清CRP水平与入院时GCS评分无明显相关性,但与入院时Fisher评分(r=0.28;P0.05)、入院时Hunt-Hess分级(r=0.42;P0.05)存在明显相关性。结论术后3 d血清CRP水平升高是a SAH不良预后的独立危险因素,能为不良预后的识别提供临床指导。     

硫酸镁治疗动脉瘤性蛛网膜下腔出血的剂量评估

目的 探讨硫酸镁对动脉瘤性蛛网膜下腔出血(SAH)后迟发性脑缺血的预防和治疗作用.方法 采用随机、对照方法,对SAH病人在发病早期静脉应用硫酸镁(24 mmol/d),连续使用至动脉瘤填塞后14 d,治疗前检查镁浓度,以后至少每2天检查1次,并与92例常规治疗的病人相比较,观察血清镁浓度能否达1.0～1.5 mmol/L的目标水平.结果 126例应用硫酸镁治疗的病人,平均镁浓度为(1.37±0.14) mmol/L,在整个治疗期间,有108例病人血清镁维持在目标水平,单次检测有2例病人血清镁浓度<1.0 mmol/L(0.79 mmol/L和0.82 mmol/L),1次或多次检测中,15例病人血镁浓度>2.0 mmol/L.结论 对大多数SAH病人来说,每天给予静脉补充24 mmol/L的硫酸镁,容易使血镁浓度维持在1.0～1.5 mmol/L,且无明显不良反应.     

急性脑出血患者血浆Ghrelin的动态变化及意义

目的分析脑出血患者血浆Ghrelin的动态变化及意义。方法选取急性脑出血患者30例为观察组,分别收集脑出血患者入院后第1天、第7天、第14天血浆标本,同时取同期健康体检患者30例作为对照组,比较各组血浆Ghrelin的水平,并进一步分析其变化的意义。结果第1天血浆Ghrelin含量(186.84±53.94)μg/L,第7天血浆Ghrelin含量(160.50±75.49)μg/L,第14天血浆Ghrelin的含量(58.58±8.11)μg/L,对照组Ghrelin含量(10.84±1.72)μg/L。血浆Ghrelin水平与脑出血量呈正相关。结论脑出血患者血浆Ghrelin呈动态变化,随着病情稳定,逐渐下降。血浆Ghrelin水平对脑出血患者的病情估计及预后有一定的临床意义。     

血清神经元特异性烯醇化酶对重型颅脑损伤患者的预后评价

目的 探讨血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)与重型颅脑损伤患者预后的关系。方法 应用ELISA法测定41例重型颅脑损伤(GCS≤8)患者血清NSE并动态观察其变化的规律。结果 预后不良的患者NSE初始值及峰值(66.40±9.46μg/L,94.24±13.75μg/L)均明显高于预后良好患者(32.16±4.21μg/L,34.08±4.40μg/L),P<0.01。NSE_初>60μg/L者,预后不良为6/8,NSE_初<60μg/L者,预后不良为5/33,P<0.001;NSE初与预后负相关,r=-0.501,P<0.01。预后良好患者NSE值3d内迅速降至正常,而预后不良患者NSE值可持续高达5d以上;NSE持续升高(NSE_初>60μg/L,下降缓慢)或继发性升高(NSE_初<60μg/L,NSE_峰>60μg/L)的患者预后不良为9/10,NSE持续低(NSE<60μg/L)或迅速下降(NSE_初>60μg/L)的患者预后良好为29/31,P<0.001。结论 重型颅脑损伤后急性期血清NSE水平与预后有密切关系,NSE是预测颅脑损伤预后的一个有价值的神经生化指标。     

SAH患者动脉瘤夹闭术后脑水肿发生情况及Logistic分析

目的 采用Logistic分析蛛网膜下腔出血(SAH)患者动脉瘤夹闭术后脑水肿发生情况。方法回顾分析于2017-01—2022-06巴中市中心医院收治的113例SAH患者的临床资料,依据行动脉瘤夹闭术后脑水肿发生情况分为脑水肿组(n=41)和未并发脑水肿组(n=72)。统计2组患者一般资料、临床疗效、动脉瘤情况、实验室资料并进行单因素分析,选取其中差异有统计学意义的项目进行Logistic多元逐步回归分析。结果 脑水肿组相较于未并发脑水肿组年龄、性别、SBP、DBP、动脉瘤位置、动脉瘤直径、手术时长差异无统计学意义(P>0.05),Hunt-Hess分级、MMP-9[(387.81±80.21)μg/L比(194.41±51.92)μg/L]、VEGF[(398.26±85.60)ng/L比(185.24±55.28)ng/L]更高(P<0.05),GCS得分[(8.45±2.16)分比(12.74±3.15)分]、GOS评分[(3.06±0.79)分比(2.62±0.78)分]得分更低,差异均有统计学意义(P<0.05),2组患者长期(>10 a)吸烟史、入院...     

Assessment of the haemostatic system in patients surgically treated for ruptured cerebral aneurysm

BACKGROUND AND PURPOSE: The aim of the study was to evaluate selected markers of thrombin generation and subsequent fibrinolysis in patients with aneurysmal subarachnoid haemorrhage (SAH) and to assess the relationship between thrombin generation/fibrinolysis and clinical course and outcome. MATERIAL AND METHODS: This prospective study included 72 patients after aneurysmal SAH who underwent surgery within 72 hours after onset of symptoms. The results were compared with 84 control patients without SAH. Selected markers of thrombin generation (thrombin-antithrombin complexes, TAT), fibrinolysis (D-dimer) and fibrinogen level were examined in blood just after admission and on day 7 after surgery. The relationship between levels of those markers and selected clinical and radiological data, and outcome at 3-6 months after surgery, were assessed. RESULTS: On admission, patients with SAH had higher levels of TAT (p<0.001), D-dimer (p=0.048), and fibrinogen than the control group (p<0.001). Also, patients with severe bleeding demonstrated higher TAT (p<0.001) and D-dimer (p=0.04) levels. The admission level of TAT (higher than 24 g/l; odds ratio = 10.8) and the elevated blood fibrinogen level (odds ratio = 1.2) showed a strong correlation with mortality. Furthermore, a level of TAT higher than 24 g/l (odds ratio = 9.98) and the level of fibrinogen (odds ratio = 1.3) strongly correlated with poor outcome. There was no significant correlation between markers of coagulation on the 7th day after surgery for SAH and the outcome. CONCLUSIONS: Activation of blood coagulation as well as the fibrinolytic system occurred early in the course of SAH. Such activation was associated with poor clinical status of patients on admission, greater amount of subarachnoid blood, and poor clinical outcome. Thus, blood levels of TAT and fibrinogen are independent factors associated with mortality and morbidity after aneurysmal SAH.     

Characteristics of MRI Findings after Subarachnoid Hemorrhage and D-Dimer as a Predictive Value for Early Brain Injury

BackgroundThe pathological mechanisms of early brain injury (EBI) have remained obscure. Several studies have reported on the neuroradiological findings of EBI. However, to our knowledge, no study has attempted to explore the mechanism of EBI after subarachnoid hemorrhage (SAH). Therefore, this study evaluates whether the initial plasma D-dimer levels were associated with EBI, classifies magnetic resonance imaging (MRI) findings, and speculates about the mechanism of EBI.MethodsThis study included 97 patients hospitalized within 24 h from the onset of nontraumatic SAH. The patients underwent MRI within 0–5 days from onset (before vasospasm) to detect EBI. EBI was radiologically defined as diffusion-weighted imaging (DWI)-positive lesions that appear dark on apparent diffusion coefficient maps, excluding procedure-related lesions. EBI, plasma D-dimer levels, and clinical features were retrospectively investigated.ResultsElevated D-dimer levels were associated with poor outcomes. Patients with EBI had significantly higher D-dimer levels than those without EBI. EBI was detected in 24 patients (27.3%) of all, and in 22 (45%) of 49 patients with World Federation of Neurosurgical Societies (WFNS) grade 4–5 SAH. EBI was frequently observed in the paramedian frontal lobe. There were several types of the pathology in EBI, including widespread symmetrical cerebral cortex lesions, focal cortex lesions, periventricular injury, and other lesions impossible to classify due to unknown mechanisms such as thrombotic complication and microcirculatory disturbance, ultra-early spasm, and spreading depolarization.ConclusionsThis study suggests that D-dimer levels predict poor outcomes in patients with SAH and that EBI was associated high D-dimer levels.     

Acute systematic inflammatory response syndrome and serum biomarkers predict outcomes after subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) can trigger immune activation sufficient to induce systematic inflammatory response syndrome (SIRS). Serum inflammatory biomarkers and SIRS can predict a poor outcome. The relationship between surgical stress and inflammatory response is well known but described in few reports in the neurosurgical population. We aimed to ascertain whether postoperative SIRS and initial serum biomarkers were associated with outcomes and evaluate whether the postoperative SIRS score differed between those with clipping and coil embolization. We evaluated 87 patients hospitalized within 24 h from onset of nontraumatic SAH. Serum biomarkers, such as levels of C-reactive protein (CRP), white blood cells (WBC), and D-dimer, as well as stress index (SI: blood sugar/K ratio) were obtained at admission. SIRS scores 3 days after admission were derived by adding the number of variables meeting the standard criteria (heart rate [HR] >90, respiratory rate [RR] >20, temperature >38 °C or <36 °C, and WBC count <4000 or >12,000). Clinical variables were compared according to whether they were associated with poor outcomes. Coil embolization was performed in 30 patients and clipping in 57. WBC, SI, D-dimer levels, and SIRS scores were significantly higher in patients with poor-grade SAH and were associated with poor outcomes. SIRS scores were significantly higher with clipping than with coil embolization among patients with good-grade SAH without intracerebral hemorrhage. Acute SIRS and serum biomarkers predict outcomes after SAH. Moreover, our study suggests the influence of surgical invasion via clipping on SIRS after SAH.     

颅脑损伤病人血浆D-二聚体变化的临床意义

目的 探讨颅脑损伤病人血浆D-二聚体变化及其临床意义。方法 回顾性分析2018月5年到2019年5月收治的100例单纯急性颅脑损伤的临床资料。采用免疫比浊法动态检测伤后1、3、5、7、9 d血浆D-二聚体水平。伤后3个月,采用GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。另选取同期健康体检者50例作为对照组。结果 100例中,预后不良28例,预后良好72例。重型颅脑损伤28例中,伤后3个月死亡8例,存活20例。颅脑损伤病人伤后血浆D-二聚体含量先增高,后降低,伤后3 d达高峰。伤后1~9 d,颅脑损伤病人血浆D-二聚体含量明显高于对照组（P<0.05）,而且,随颅脑损伤程度加重,血浆D-二聚体含量明显增高（P<0.05）。伤后1~7 d,预后不良组血浆D-二聚体含量明显高于预后良好组（P>0.05）,伤后9 d,两组无统计学差异（P>0.05）。28例重型颅脑损伤中,死亡病人伤后1~3 d血浆D-二聚体含量明显高于存活病人（P<0.05）;伤后5~9 d,死亡病人和存活病人血浆D-二聚体含量无统计学差异（P>0.05）。结论 动态监测血浆D-二聚体有助于早期、快速判断颅脑损伤病人伤情及预后     

D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study

Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission(within 48 hours after initial hemorrhage) and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.     

Effects of plasma D-dimer levels on early mortality and long-term functional outcome after spontaneous intracerebral hemorrhage

The activation of hemostatic systems has been detected in spontaneous intracerebral hemorrhage (ICH) patients. The influence of plasma D-dimer levels on clinical outcome remains unclear. This study aimed to investigate the impact of elevated plasma D-dimer levels on early mortality and long-term functional outcome in spontaneous ICH. A total of 259 spontaneous ICH patients (<24 hours from ictus) between November 2010 and October 2011 were included. Clinical information and radiological findings were collected at admission. Spearman correlation analyses revealed that D-dimer concentrations were correlated with midline shift, hematoma volume, intraventricular hemorrhage (IVH) score and Glasgow Coma Scale score. Patients with subarachnoid extension had significantly higher D-dimer levels than those without SAH extension. Comparison of patients with IVH and those without yielded a similar result. Multivariate stepwise backward logistic analysis identified plasma D-dimer levels as an independent risk factor for 7 day mortality (adjusted odds ratio [OR] = 1.237, 95% confidence interval [CI] 1.017–1.504, p = 0.033) and 3 month poor functional outcome (modified Rankin Scale score ⩾3) (adjusted OR = 2.279, 95% CI 1.130–6.595, p = 0.026). The mechanisms by which elevated D-dimer affects the prognoses of spontaneous ICH patients remain unclear and require clarification in future studies.     

Vasopressin and oxytocin in CSF and plasma of patients with aneurysmal subarachnoid haemorrhage

Objective

Clinicopathological studies on patients succumbing to subarachnoid haemorrhage (SAH) demonstrated hypothalamic lesions. The implication of the hypothalamic neuropeptides arginine-vasopressin (AVP) and oxytocin (OXT) has not been linked to aneurysmal SAH yet. This study investigates AVP and OXT in CSF and plasma of patients with spontaneous aneurysmal SAH and their association with outcome.

Methods

CSF and plasma samples of 12 patients with aneurysmal SAH were prospectively studied for 2 weeks. AVP and OXT were measured by radioimmunoassay. Outcome was assessed on Glasgow-Outcome-Scale. Twenty-nine patients without neuropsychiatric disturbances served as controls. Differences in neuropeptide concentration time courses were assessed by regression models. Group comparisons were performed by Kruskal–Wallis and correlations by Spearman tests.

Results

Regression of CSF levels between patients with poor and good outcome revealed significantly lower levels of AVP in patients with poor outcome (p = 0.012) while OXT showed a trend towards lower levels (p = 0.063). In plasma, no significant differences between outcome groups were found. Group comparisons between poor outcome patients and controls revealed significant differences in CSF for AVP (p = 0.001) and OXT (p = 0.015). In plasma, AVP yielded significantly different results while OXT did not. No differences were found between the good outcome group and controls. Plasma and CSF concentrations showed no significant correlation.

Conclusion

Patients with poor outcome after aneurysmal SAH have lower AVP and OXT levels in CSF than patients with good outcome while neuropeptide levels in plasma failed to reflect differences in outcome. The data indicate hypothalamic damage as an aetiologic factor for outcome after aneurysmal SAH.     

Perivascular neuropeptides (NPY, VIP, CGRP and SP) in human brain vessels after subarachnoid haemorrhage

Introduction - Cerebral blood vessels are innervated by sympathetic nerve fibres storing neuropeptide Y (NPY), parasympathetic nerves storing acetylcholine, vasoactive intestinal peptide (VIP) and sensory afferent fibres containing calcitonin gene-related peptide (CGRP), substance P (SP) and neurokinin A. In experimental studies on subarachnoid haemorrhage (SAH) there are indications that perivascular peptides are involved. In the present study we have in man measured the levels of NPY, VIP, SP and CGRP in brain vessels of patients that have suffered a fatal SAH and compared this with the levels encountered in subjects that died of an extracerebral cause. Material and methods – Vessels from patients who have died from SAH or nonSAH were obtained during autopsy performed within 24 hrs after death. The peptides were extracted and fractionated with reversed phase liquid chromatography (HPLC). The levels of NPY, VIP, SP, and CGRP were measured with radioimmunoassay. Vasomotor responses of human cerebral arteries were Results – Human cerebral vessels contained NPY, VIP, CGRP and SP which eluted at the same positions as the authentic peptides. The level of CGRP was significantly lower (p < 0.01) in arteries removed from SAH patients as compared to control subjects. The level of SP was not changed, if anything it tended to be increased after SAH. The levels of NPY and VIP were not significantly altered after SAH. In isolated brain vessels α-CGRP was a potent vasodilator of arteries precontracted with whole blood, prostaglandin F_2α or endothelin. It had a poor effect on vessels precontracted with 60 mM potassium. Conclusion – The evidence suggest that the trigemino-cerebrovascular system, storing CGRP and SP, is to a differential degree involved in the pathophysiology of SAH in man and supports the hypothesis of an exhaustion of CGRP as one important factor in the development of late spasm occuring after SAH.     

Predictors of Poor Outcome in Patients with Acute Cerebral Infarction

Background and Purpose

Plasma D-dimer levels are elevated during the acute phase of cerebral infarction (CI). We investigated whether the D-dimer level on admission and other clinical characteristics could be used to predict the poor outcome of patients with acute CI.

Methods

The clinical characteristics and plasma D-dimer levels measured within 3 days of onset were compared according to outcome among patients with acute CI.

Results

In total, 359 consecutive patients (mean age, 71.8 years) were examined, of which 174 had a poor outcome [score on the modified Rankin scale (mRS) ≥3] at 30 days after hospitalization. The mean mRS score was higher and a poor outcome was observed more frequently among women than among men (p<0.001 for each). The proportions of women, cardioembolism, atrial fibrillation, advanced age (≥75 years), prior history of CI or transient ischemic attack, and elevated D-dimer level (≥1.0 µg/mL) were significantly higher among patients with a poor outcome than among those with a good outcome. A multivariate analysis showed that elevated D-dimer level [≥1.0 µg/mL; odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.52-3.89; p<0.01], advanced age (OR, 1.93; 95% CI, 1.21-3.07; p<0.01), and female gender (OR, 1.75; 95% CI, 1.08-2.83; p=0.02) were independent predictors of a poor outcome.

Conclusions

Certain clinical characteristics (gender and advanced age) and an elevated D-dimer level upon admission can be used to predict the outcome of patients with acute CI at 30 days after hospitalization.