Xu Nan, Fu Yakun, Wang Shuanglin, Li Shenghui, Cai Dong
Department of Infectious Diseases, Tianjin Medical University General Hospital, Tianjin, China.
NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin, China.
J Clin Lab Anal. 2020 May;34(5):e23206. doi: 10.1002/jcla.23206. Epub 2020 Feb 3.
Ischemic stroke is one of the most prominent and serious neurological complications of infective endocarditis (IE). Our study was designed to evaluate the predictive value of higher level of plasma D-dimer on admission for the development of ischemic stroke in patients with IE.
In this prospective study, a total of 173 consecutive patients with IE were recruited from January 2016 to December 2018. Plasma D-dimer and other clinical indexes of IE patients were measured after admission. The number of patients who developed ischemic stroke during 6-month follow-up was recorded, as well as the occurrence time of ischemic stroke.
Ischemic stroke was observed in 38 (22%) patients during 6-month follow-up since definite diagnosis of IE. Patients with ischemic stroke had significantly higher levels of plasma D-dimer than those of patients without stroke (4982 vs 2205 μg/L, P < .001). In addition, Staphylococcus aureus infection (HR: 1.96, 95% CI: 1.51-2.42), mitral valve vegetation (HR: 1.52, 95% CI: 1.32-1.75), and higher levels of on-admission plasma D-dimer (HR: 1.35, 95% CI: 1.27-1.43) were significantly associated with ischemic stroke. Moreover, D-dimer levels ≥3393 μg/L served as a strong predictor for ischemic stroke in patients with IE, and the sensitivity and specificity were 78% and 83%, respectively.
Our study suggested that higher level of D-dimer on admission was an independent predictor for ischemic stroke in patients with IE. These patients may require special attention, in particular within the first trimester after IE diagnosis.
缺血性卒中是感染性心内膜炎（IE）最突出且严重的神经并发症之一。我们的研究旨在评估入院时血浆D - 二聚体水平升高对IE患者发生缺血性卒中的预测价值。
在这项前瞻性研究中，2016年1月至2018年12月共纳入173例连续的IE患者。入院后测量IE患者的血浆D - 二聚体及其他临床指标。记录6个月随访期间发生缺血性卒中的患者数量以及缺血性卒中的发生时间。
自明确诊断IE起6个月的随访期间，38例（22%）患者发生了缺血性卒中。发生缺血性卒中的患者血浆D - 二聚体水平显著高于未发生卒中的患者（4982对2205μg/L，P <.001）。此外，金黄色葡萄球菌感染（HR：1.96，95%CI：1.51 - 2.42）、二尖瓣赘生物（HR：1.52，95%CI：1.32 - 1.75）以及入院时较高的血浆D - 二聚体水平（HR：1.35，95%CI：1.27 - 1.43）与缺血性卒中显著相关。此外，D - 二聚体水平≥3393μg/L是IE患者发生缺血性卒中的有力预测指标，敏感性和特异性分别为78%和83%。
我们的研究表明，入院时较高的D - 二聚体水平是IE患者发生缺血性卒中的独立预测指标。这些患者可能需要特别关注，尤其是在IE诊断后的头三个月内。
