Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage |
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| Institution: | 1. Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Taiwan;2. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan;3. Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Taiwan;4. Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan;5. Department of Neurosurgery, School of Medicine, Johns Hopkins University, 6128 Zayed Tower, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21218, USA;6. Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Taiwan;7. Department of Neurology and Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan;1. Department of Neurology, University of Missouri in Columbia, Five Hospital Drive CE 537 DC 047.00, Columbia, MO 65212, USA;2. Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA;1. Spinal Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK;2. Spinal Unit, Clinico San Carlos Hospital, Madrid 28040, Spain;1. Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, Changzhou 213200, China;2. Department of Cerebral Surgery, Affiliated Hospital of Nanjing Medical University, Changzhou Second People’s Hospital, Changzhou 213003, China;3. Nanjing Medical University, Nanjing 210029, China;4. Department of Orthopaedic Trauma, Affiliated Hospital of Nanjing Medical University, Changzhou Second People’s Hospital, Changzhou 213003, China;5. Central Laboratory, Changzhou Second People’s Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou 213003, China;1. University of Illinois, Department of Neurological Surgery, Chicago, IL 60612, USA;2. Emory University School of Medicine, Department of Neurological Surgery, Atlanta, GA 30307, USA;3. University of Miami Miller School of Medicine, Department of Neurological Surgery, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL 33136, USA |
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| 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 (D0) 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. |
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| Keywords: | CSF D-dimer Intracerebral hemorrhage Intraventricular hemorrhage |
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