Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, JiangSu, China.
J Neurointerv Surg. 2023 Dec 21;15(e3):e375-e380. doi: 10.1136/jnis-2022-019719.
Symptomatic intracranial hemorrhage (sICH) is a common and severe complication in patients with acute ischemic stroke (AIS) after treatment with thrombectomy.
To explore the ability of admission plasma D-dimer levels to predict sICH after thrombectomy.
Between February 2018 and August 2021, consecutive patients with AIS who underwent thrombectomy at our single comprehensive stroke center were retrospectively enrolled. sICH was defined according to the criterion of the Heidelberg Bleeding Classification. Logistic regression analysis was performed to determine the risk factors of sICH. The overall discriminative ability of D-dimer levels in predicting sICH was evaluated by adopting a receiver operating characteristic (ROC) curve.
Of the 395 enrolled patients, 48 (12.2%) had sICH. Patients with sICH were older (72.9 vs 69.3 years, P=0.037), more often female (62.5% vs 45.5%, P=0.027), had higher D-dimer levels (2.70 vs 0.74 mg/L, P<0.001), higher National Institutes of Health Stroke Scale score (20 vs 15, P<0.001), lower Alberta Stroke Program Early CT Score (8 vs 9, P<0.001), a higher proportion of internal carotid artery occlusions (56.2% vs 30.3%, P<0.001), and less commonly had large-artery atherosclerosis stroke etiology (12.5% vs 32.3%, P=0.010) than patients without sICH. After adjustment for potential confounders, D-dimer levels (adjusted OR=2.45, 95% CI 1.75 to 3.43, P<0.001) remained significantly associated with sICH. Based on the ROC, the D-dimer as a predictor for predicting sICH, presented with a specificity of 86.2%, a negative predictive value of 94.6%, and an area under the curve of 0.774.
Elevated admission D-dimer levels are an independent predictor of sICH in patients with AIS after thrombectomy.
症状性颅内出血（sICH）是急性缺血性脑卒中（AIS）患者接受血栓切除术治疗后的常见且严重的并发症。
探讨入院时血浆 D-二聚体水平对血栓切除术后 sICH 的预测能力。
回顾性纳入 2018 年 2 月至 2021 年 8 月期间在我们单中心综合性卒中中心接受血栓切除术的连续 AIS 患者。根据海德堡出血分类标准定义 sICH。采用 Logistic 回归分析确定 sICH 的危险因素。采用受试者工作特征（ROC）曲线评估 D-二聚体水平对 sICH 的整体判别能力。
共纳入 395 例患者，其中 48 例（12.2%）发生 sICH。与未发生 sICH 的患者相比，发生 sICH 的患者年龄更大（72.9 岁比 69.3 岁，P=0.037），女性比例更高（62.5%比 45.5%，P=0.027），D-二聚体水平更高（2.70mg/L 比 0.74mg/L，P<0.001），美国国立卫生研究院卒中量表评分更高（20 分比 15 分，P<0.001）， Alberta 卒中项目早期 CT 评分更低（8 分比 9 分，P<0.001），颈内动脉闭塞比例更高（56.2%比 30.3%，P<0.001），大动脉粥样硬化性卒中病因比例更低（12.5%比 32.3%，P=0.010）。调整潜在混杂因素后，D-二聚体水平（调整 OR=2.45，95%CI 1.75 至 3.43，P<0.001）与 sICH 仍显著相关。基于 ROC，D-二聚体作为 sICH 预测因子，其特异性为 86.2%，阴性预测值为 94.6%，曲线下面积为 0.774。
入院时 D-二聚体水平升高是 AIS 患者血栓切除术后 sICH 的独立预测因子。
