What the fuck good does prediction of non-recovery do? Do you tell your patients you have nothing that will get them 100% recovered? Or will you be like my doctor and know nothing and do nothing about stroke?
A Systematic Review of the Predictive Value of Plasma D-Dimer Levels for Predicting Stroke Outcome
Peng Zhang1, 
Shiliang Zhang- 1Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
- 2Department of Cardiology, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
- 3Department of Cardiovascular and Cerebrovascular, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
Background: Stroke is a leading cause of morbidity and mortality. Over the past decade, plasma D-dimer levels have emerged as a biomarker for predicting stroke outcome. However, no consensus in the literature currently exists concerning its utility for predicting post-stroke functional outcome and mortality.
Objective: To systematically review the effectiveness of plasma D-dimer levels for predicting functional outcome and mortality following stroke.
Methods: Five academic databases were screened according to PRISMA guidelines for eligible studies. With these studies, we conducted a random-effect meta-analysis to evaluate the impact of plasma D-dimer levels for predicting functional outcome and mortality post-stroke. We also conducted subgroup analyses to evaluate differences in predictive capacity for different stroke subtypes.
Results: Nineteen studies were included, containing data on 5,781 stroke patients (mean age: 65.26 ± 6.4 years). Overall methodological quality for the included studies was high. Meta-analysis showed that increased D-dimer levels were predictive of worsened functional outcomes (Hazard ratio: 2.19, 95% CI: 1.63–2.93) and elevated overall mortality (2.29, 1.35–3.88). Subgroup analysis showed that plasma D-dimer levels were more predictive of poorer functional outcomes for ischemic (2.08, 1.36–3.18) stroke as compared to intracerebral hemorrhage (2.62, 1.65–4.17). We also noted that predictive capacity was similar when it came to mortality in patients with cryptogenic ischemic stroke (2.65, 0.87–8.08) and intracerebral hemorrhage (2.63, 1.50–4.59).
Conclusion: The study provides preliminary evidence concerning the capacity of plasma D-dimer levels for predicting functional outcomes and mortality following stroke and reports that higher D-dimer levels of are associated with poorer functional outcomes and higher mortality.
Introduction
Stroke is the second most common cause of death or disability worldwide (1, 2). Characterized as a cerebrovascular accident that hampers blood flow resulting in brain damage (3), stroke accounts for almost 5.5 million deaths and 116.4 million disability-adjusted life-years per year (4, 5).
Brain structural damage in stroke patients occurs due to either blood vessel occlusion or intracerebral hemorrhage (6, 7). The resultant ischemic damage then initiates a signaling cascade that triggers excitotoxic and/or inflammatory mechanisms eventually resulting in cellular apoptosis (8). Studies suggest that hemodynamic restoration is the primary mode for limiting neural injury (9, 10). However, this approach does not completely eliminate morbidity and mortality (7, 11). As such, preemptive diagnosis is imperative and is widely recommended (12–16).
D-dimers, such as circulating fibrin-degradation products, have recently been shown to be critical for predicting short- and long-term stroke-related outcomes (12, 17, 18). The presence of D-dimers can be representative of total fibrin concentrations, thereby serving as a biomarker for intravascular fibrinolysis and intravascular thrombus formation (19, 20). For stroke patients, this biomarker can detect disrupted vessels, dissolved clots, and the release of stroke-related tissue factors. D-dimers also serve as a good biomarker because of its prolonged stability, half-life, cost-effectiveness, and high sensitivity (> 97%) (21–24).
To date, only a few individual retrospective cohort studies have attempted to evaluate whether plasma D-dimer levels can predict future functional outcomes and mortality post-stroke (25–28). These studies have not established a consensus here. While some studies reported a positive correlation between mortality and plasma D-dimer levels (29–32), others have reported weaker or no correlation (27, 33, 34). Similarly, there is also no consensus concerning whether D-dimer levels are predictive for overall functional outcome. Some studies noted that plasma D-dimer levels were related to worse functional outcomes (26, 31, 33, 35), other have reported limited correlations (25, 28). To date, we have located one systematic review that attempted to evaluate the predictive capacity for plasma D-dimers (12). However, this review failed to include a meta-analysis. Moreover, since it was published in 2009, an update centered around the current evidence is strongly warranted. While a recently published meta-analysis did attempt to evaluate the prognostic impact of plasma D-dimer levels on mortality, it only contained two studies (17). We therefore, in this present systematic review and meta-analysis, attempt to evaluate the capacity for plasma D-dimer levels to predict post-stroke functional outcome and mortality.
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