Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Peking University International Hospital, Beijing, China.
J Stroke Cerebrovasc Dis. 2023 Dec;32(12):107433. doi: 10.1016/j.jstrokecerebrovasdis.2023.107433. Epub 2023 Oct 31.
Early fibrinolysis disorder exists in aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate the association of markers of early fibrinolysis disorder with poor 90-day prognosis in patients with aSAH.
A total of 693 consecutive aSAH patients from April 2020 to December 2022 were selected from the Long-term Prognosis of Emergency Aneurysmal Subarachnoid Hemorrhage (LongTEAM) trial. Poor 90-day prognosis was defined as a modified Rankin Scale 3-6 at 90 days after discharge. D-dimer (DD) and Fibrin degradation product (FDP) levels on admission were used to assess fibrinolysis disorder and patients were classified according to their quartiles. Multivariable logistic regression analysis was used to determine the association.
Of 693 patients included, 131 (18.9%) had poor 90-day prognosis. Patients in the highest quartile of DD and FDP levels had higher risk of poor 90-day prognosis than those in the first quartile (DD: adjusted odds ratio [aOR]=2.22, 95% confidence interval [CI], 1.13-4.36, p = 0.021; FDP: aOR=2.87, 95% CI, 1.48-5.58, p = 0.002), after adjusting for potential risk factors. Meanwhile, a linear dose-response relationship between DD and FDP and poor 90-day prognosis was found. Subgroup analysis showed that DD and FDP were consistently associated with poor 90-day prognosis across subgroups, and no intergroup interaction was found. Interestingly, the associations of DD and FDP with poor 90-day prognosis were more significant in low-grade aSAH patients.
Elevated markers of early fibrinolysis disorder, including DD and FDP on admission, were associated with poor 90-day prognosis in aSAH patients.
蛛网膜下腔出血（aSAH）存在早期纤溶紊乱。本研究旨在探讨 aSAH 患者早期纤溶紊乱标志物与 90 天预后不良的关系。
从 2020 年 4 月至 2022 年 12 月的 Long-term Prognosis of Emergency Aneurysmal Subarachnoid Hemorrhage（LongTEAM）试验中，共选择了 693 例连续的 aSAH 患者。90 天预后不良定义为出院后 90 天改良 Rankin 量表 3-6 分。入院时 D-二聚体（DD）和纤维蛋白降解产物（FDP）水平用于评估纤溶紊乱，根据四分位数对患者进行分类。采用多变量逻辑回归分析确定相关性。
在 693 例患者中，131 例（18.9%）90 天预后不良。与第 1 四分位组相比，DD 和 FDP 水平最高四分位组的患者 90 天预后不良的风险更高（DD：调整后的优势比[aOR]=2.22，95%置信区间[CI]，1.13-4.36，p=0.021；FDP：aOR=2.87，95%CI，1.48-5.58，p=0.002），调整了潜在的危险因素。同时，发现 DD 和 FDP 与 90 天预后不良之间存在线性剂量反应关系。亚组分析表明，DD 和 FDP 与 90 天预后不良的相关性在各亚组中一致，且组间无交互作用。有趣的是，DD 和 FDP 与 90 天预后不良的相关性在低级别 aSAH 患者中更为显著。
入院时升高的早期纤溶紊乱标志物，包括 DD 和 FDP，与 aSAH 患者 90 天预后不良相关。
