Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China.
China National Clinical Research Center for Neurological Diseases Beijing China.
J Am Heart Assoc. 2021 Feb 2;10(3):e018600. doi: 10.1161/JAHA.120.018600. Epub 2021 Jan 8.
Background D-dimer is involved in poor outcomes of stroke as a coagulation biomarker. We aimed to investigate the associations of the level and increase in D-dimer between baseline and 90 days with all-cause death or poor functional outcome in patients after ischemic stroke or transient ischemic attack. Methods and Results We collected data from the CNSRIII (Third China National Stroke Registry) study. The present substudy included 10 518 patients within 7 days (baseline) of ischemic stroke or transient ischemic attack and 6268 patients at 90 days. Poor functional outcome at 1 year was assessed on the basis of the modified Rankin Scale (≥3). Multivariable Cox regression or logistic regression was used to assess the association of D-dimer levels with all-cause death or poor functional outcome. D-dimer levels at 90 days were lower than those at baseline (1.4 µg/mL versus 1.7 µg/mL; <0.001). Higher baseline D-dimer level was associated with all-cause death (adjusted hazard ratio [HR], 1.77; 95% CI, 1.25-2.52; =0.001) and poor functional outcome (adjusted odds ratio [OR], 1.49; 95% CI, 1.23-1.80; <0.001) during 1-year follow-up. Higher D-dimer level at 90 days was also associated with poor outcomes independently. Furthermore, an increase in D-dimer levels between baseline and 90 days was associated with all-cause death (since 90 days to 1 year after index event) (adjusted HR, 1.99; 95% CI, 1.12-3.53; =0.019) but not with poor functional outcome (adjusted OR, 1.08; 95% CI, 0.82-1.41). Conclusions Our study shows that high level and an increase in D-dimer between baseline and 90 days are associated with poor outcomes in patients after ischemic stroke or transient ischemic attack.
背景 D-二聚体作为一种凝血生物标志物，与卒中不良结局相关。本研究旨在探讨基线时和 90 天时 D-二聚体水平及其变化与缺血性卒中和短暂性脑缺血发作后患者全因死亡或不良功能结局的相关性。
方法 我们从 CNSRIII（第三次中国国家卒中登记研究）中收集数据。本亚研究纳入了缺血性卒中和短暂性脑缺血发作后 7 天内（基线）的 10518 例患者和 90 天内的 6268 例患者。根据改良 Rankin 量表（≥3 分）评估 1 年时的不良功能结局。采用多变量 Cox 回归或 logistic 回归分析评估 D-二聚体水平与全因死亡或不良功能结局的相关性。90 天时的 D-二聚体水平低于基线时（1.4μg/ml 比 1.7μg/ml；<0.001）。较高的基线 D-二聚体水平与全因死亡（校正后的风险比[HR]，1.77；95%可信区间[CI]，1.25-2.52；=0.001）和不良功能结局（校正后的比值比[OR]，1.49；95%CI，1.23-1.80；<0.001）相关，随访 1 年时也是如此。90 天时 D-二聚体水平升高也与不良结局独立相关。此外，基线至 90 天期间 D-二聚体水平升高与全因死亡（自指数事件发生后 90 天至 1 年）相关（校正后的 HR，1.99；95%CI，1.12-3.53；=0.019），但与不良功能结局无关（校正后的 OR，1.08；95%CI，0.82-1.41）。
结论 本研究表明，缺血性卒中和短暂性脑缺血发作后患者的基线时和 90 天时 D-二聚体水平较高和升高与不良结局相关。
