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VOLUME 25 , ISSUE 2 ( February, 2021 ) > List of Articles

Pediatric Critical Care

D-dimer Level is Correlated with Prognosis, Infarct Size, and NIHSS in Acute Ischemic Stroke Patients

Nora I Abbas, Osama Sayed, Sherif Samir, Nashwa Abeed

Citation Information : Abbas NI, Sayed O, Samir S, Abeed N. D-dimer Level is Correlated with Prognosis, Infarct Size, and NIHSS in Acute Ischemic Stroke Patients. Indian J Crit Care Med 2021; 25 (2):193-198.

DOI: 10.5005/jp-journals-10071-23744

License: CC BY-NC 4.0

Published Online: 01-02-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Stroke ranks the fourth leading disease causing adult mortality and disability. D-dimer (D-D) is the ultimate product of plasmin-mediated degradation of fibrin-rich thrombi. D-D is a simple readily accessible biomarker employed within the diagnostic algorithms for the exclusion of venous thromboembolism. The correlation between D-D infarct size in MRI brain, APACHE II score, and the National Institute of Health Stroke Scale (NIHSS) score in critically ill acute stroke patients has not been fully investigated before. Objective: We aimed to investigate the diagnostic and prognostic value of elevated plasma D-D in critically ill patients admitted with acute cerebrovascular accidents. As far as we know, we are the first to investigate the correlation between plasma D-D levels and the ischemic lesion size in MRI brain and also APACHE II score and NIHSS in critically ill acute ischemic cerebrovascular patients. Setting and participants: A prospective, observational cohort study inside the Critical Care Medicine Department. Thirty patients with AIS were enrolled additionally to 1 healthy age- and sex-matched controls. Interventions: We employed particle-enhanced, immunoturbidimetric assay to detect plasma D-D concentrations. D-D levels D0 and D1 were measured upon admission and 24 hours later, respectively. We reviewed the patient's health records; additionally, demographic, clinical, laboratory, and neuroimaging information was abstracted. Results: D-D concentrations were significantly higher in acute stroke patients compared to healthy controls. ROC curve analysis showed that elevated D-D level more than 310 ng/mL can predict infarct lesion size >1.5 cm in diffusion-weighted MRI brain with sensitivity and specificity (100 and 83%, respectively) and also admission D-D (D0) at cutoff concentration 350 ng/mL and D1 at cutoff value 370 ng/mL are predictors of complicated course with sensitivity and specificity (100 and 84.6%, respectively). There was no significant difference between D0 and D1 D-D levels (p-value >0.05). Conclusion: The plasma D-D biomarker can be a simple readily available test reliable predictor of infarct lesion size >1.5 cm in DW-MRI and outcome in union with the common practice instrumental tests.

  1. Mozaffarian D, Benjamin EJ, Go AS, Donna K. Arnet, M.J Blaha, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015 Jan 27;131(4):e29–e322. DOI: 10.1161/CIR.0000000000000152.
  2. Whiteley W, Chong W, Sengupta A, Sandercock P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke 2009;40(5):380–389. DOI: 10.1161/STROKEAHA.108.528752.
  3. Meng R, Wang X, Hussain M, Dornbos D III, Meng L, Liu Y, et al. Evaluation of plasma D-dimer plus fibrinogen in predicting acute CVST. Int J Stroke 2014 Feb;9(2):166–173. DOI: 10.1111/ijs.12034.
  4. Park YW, Koh EJ, Choi HY. Correlation between serum D-dimer level and volume in acute ischemic stroke. J Korean Neurosurg Soc 2011;50(2):89–94. DOI: 10.3340/jkns.2011.50.2.89.
  5. Yang XY, Gao S, Ding J, Chen Y, Zhou XS, Wang JE. Plasma D-dimer predicts short term poor outcome after acute ischemic stroke. PLoS One 2014 Feb 24;9(2):e89756. DOI: 10.1371/journal.pone.0089756.
  6. Goldenberg NA, Jenkins S, Jack J, Armstrong-Wells J, Fenton LZ, Stence NV, et al. Arteriopathy, D-dimer, and risk of poor neurologic outcome in childhood onset arterial ischemic stroke. J Pediatr 2013;162(5):1041–1046. DOI: 10.1016/j.jpeds.2012.11.035.
  7. Školoudík D, Bar M, Šaňák D et al. D-dimers increase in acute ischemic stroke patients with the large artery occlusion, but do not depend on the time of artery recanalization. J Thromb Thrombolysis 2010;29:477–482. DOI:
  8. Berge E, Friis P, Sandset P. Hemostatic activation in acute ischemic stroke. Thromb Res 2001 Jan 15;101(2):13–21. DOI: 10.1016/s0049-3848(00)00380-7.
  9. Delgado P, Alvarez-Sabin J, Abilleira S, Santamarina E, Purroy F., Arenillas JF, et al. Plasma D-dimer predicts poor outcome after acute intracerebral hemorrhage. Neurology 2006;67(1):94–98. DOI: 10.1212/01.wnl.0000223349.97278.e0.
  10. Righini M, Goehring C, Bounameaux H, Perrier A. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 2000;109(5):357–361. DOI: 10.1016/S0002-9343(00)00493-9.
  11. Isenegger J, Meier N, Lammle B, Isenegger J, Meier N, Lämmle B, et al. D-Dimers predict stroke subtype when assessed early. Cerebrovasc Dis 2010;29(1):82–86. DOI: 10.1159/000256652.
  12. Abdel Ghani AAM, Zaitoun AM, Gawish HaH, AboWarda MH. Prognostic value of D-dimer in diffusion weighted-MRI defined early ischemic stroke recurrence. Egypt J Neurol Psychiat Neurosurg 2011;48(3):215–222. DOI: 10.4103/1110-1083.192656. The article is available from available from:
  13. Schlegel D, Kolb S, Luciano J, Tovar JM, Cucchiara BL, Liebeskind DS, et al. Utility of the NIH Stroke Scale as a predictor of hospital disposition. Stroke 2003;34(1):134–137. DOI: 10.1161/01.str.0000048217.44714.02.
  14. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993 Jan;24(1):35–41. DOI: 10.1161/01.str.24.1.35.
  15. Mackay J, Mensah GA. The atlas of heart disease and stroke. In: Global burden of stroke. World Health Organization and Center for Disease Control and Prevention; 2004. Available from:
  16. Laskowitz D, Blessing R, Floyd J, White WD, Lynch JR. Panel of biomarkers predicts stroke. Ann NY Acad Sci 2005;1053:30. DOI: 10.1196/annals.1344.051.
  17. Gurkan ZM, Orken DN, Tekan UY, Çelebi LG, Tak AZ, et al. D-Dimer levels in etiological diagnosis of ischemic stroke and relationship the prognosis. SETB 2013;47(1):1–4. DOI: 10.5350/SEMB2013470101.
  18. Zi WJ, Shuai J. Plasma D dimer levels are associated with stroke subtypes and infarction volume in patients with acute stroke. PLoS One 2014;9(1):e86465. DOI: 10.1371/journal.pone.0086465. PMCID: PMC3896474.
  19. Matsumoto M, Sakaguchi M, Okazaki S, Furukado S, Tagaya M, Etani H, et al. Relationship between plasma D-dimer levels and cerebral infarction volume in patients with non-valvular AF. Cerebrovasc Dis 2013;35(1):64–72. DOI: 10.1159/000345336.
  20. Knauer C, Knauer K, Muller S, Ludolph AC, Bengel D, Müller HP, et al. A biochemical marker panel in MRI-proven hyper acute ischemic stroke—a prospective study. BMC Neurol 2012 Mar 8;12:14. DOI: 10.1186/1471-2377-12-14.
  21. Linkins LA, Lapner ST. Review of D-dimer testing: good, bad, and ugly. Int J Lab Hematol 2017 May;39(Suppl. 1):98–103. DOI: 10.1111/ijlh.12665.
  22. Feinberg WM, Erickson LP, Bruck D, Kittelson J. Hemostatic markers in acute ischemic stroke: association with stroke type, severity and outcome. Stroke 1996;27:1296–1300. DOI: 10.1161/01.STR.27.8.1296.
  23. Ustundag M, Orak M, Guloglu C, Tamam Y, Sayhan MB. Plasma D-dimer levels in acute ischemic stroke: association with mortality, stroke type and prognosis. Nobel Med 2010;6(2):37–42. The article is available from Available from:
  24. Ageno W, Finazzi S, Steidl L, Biotti MG, Mera V, Melzi D'Eril G, et al. Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes. Arch Intern Med 2002 Dec 9–23;162(22):2589–2593. DOI: 10.1001/archinte.162.22.2589.
  25. Koch HJ, Horn M, Bogdahn U, Ickenstein GW. The relationship between plasma D-dimer concentrations and acute ischemic stroke subtypes. J Stroke Cerebrovasc Dis 2005; 14: 75–79. DOI: 10.1016/j.jstrokecerebrovasdis.2004.12.002.
  26. Yuan W, Shi ZH. The relationship between plasma D-dimer levels and outcome of Chinese acute ischemic stroke patients in different stroke subtypes. J Neural Transm (Vienna) 2014 Apr;121(4):409–413. DOI: 10.1007/s00702-013-1113-y.
  27. Krarup LH, Sandset EC, Sandset PM, Berge E. D-Dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand 2011 Jul;124(1):40–44. DOI: 10.1111/j.1600-0404.2010.01409.x.
  28. Kabrhel C, Mark Courtney D, Camargo CA, Plewa MC, Nordenholz KE, Moore CL, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med 2010;17(6):589–597. DOI: 10.1111/j.1553-2712.2010.00765.x. PMC: 3538031. PMID: 20624138.
  29. Baglin T, Keeling D, Kitchen S. Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: guidance from the British Committee for Standards in Haematology. Br J Haematol 2012 November;159(4):427–429. DOI: 10.1111/bjh.12052. PMID: 22970737.
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