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

Chih Wei Chen, En Hsuan Wu, Judy Huang, Wen-Tsan Chang, Kam Hou Ao, Tain Junn Cheng, Wuyang Yang

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)149-154
Number of pages6
JournalJournal of Clinical Neuroscience
Volume29
DOIs
Publication statusPublished - 2016 Jul 1

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Cerebral Hemorrhage
Cerebrospinal Fluid
Hemorrhage
Mortality
Survivors
fibrin fragment D
Hematoma
Drainage
Prospective Studies
Costs and Cost Analysis
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

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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",
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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Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage. / Chen, Chih Wei; Wu, En Hsuan; Huang, Judy; Chang, Wen-Tsan; Ao, Kam Hou; Cheng, Tain Junn; Yang, Wuyang.

In: Journal of Clinical Neuroscience, Vol. 29, 01.07.2016, p. 149-154.

Research output: Contribution to journalArticle

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T1 - Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage

AU - Chen, Chih Wei

AU - Wu, En Hsuan

AU - Huang, Judy

AU - Chang, Wen-Tsan

AU - Ao, Kam Hou

AU - Cheng, Tain Junn

AU - Yang, Wuyang

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