Integrative Biomedical Research
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN 3068-6326
743
Citations
1.5m
Views
738
Articles
Volume 7 Number 2 2023
RESEARCH ARTICLE (Open Access)
Admission D-Dimer, Procalcitonin, and C-Reactive Protein Predict Stroke Severity and Short-Term Outcome in Acute Ischemic Stroke
Md. Raknuzzaman1*, Tasnim Jannaty2, Abu Shams Md. Hasan Ali Masum3, Md. Wahiduzzaman4, Mohammad Aftab Rassel1, S M Arfath Amin5, Pijush Paul5, Md. Ashrafuzzaman Khan5
Journal of Angiotherapy 7 (2) 1-8 https://doi.org/10.25163/angiotherapy.7210453
Submitted: 29 May 2023 Revised: 03 August 2023 Accepted: 11 August 2023 Published: 14 August 2023
Abstract
Background: Acute ischemic stroke remains a major cause of mortality and long-term neurological disability worldwide. Increasing evidence suggests that inflammatory and coagulation-related biomarkers may reflect the severity of cerebral injury and influence clinical outcome. However, the prognostic significance of admission plasma D-dimer, serum procalcitonin, and C-reactive protein (CRP) in acute ischemic stroke has not been fully clarified, particularly in resource-limited clinical settings.Methods: This multicenter observational study included 260 patients diagnosed with acute ischemic stroke who were admitted to tertiary hospitals in Bangladesh. Patients were categorized according to CRP status into CRP-positive and CRP-negative groups. Clinical severity was assessed using the Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (mRS). Plasma D-dimer, serum procalcitonin, and CRP levels were measured during admission. Patients were followed for short-term outcomes and mortality assessment up to 30 days after stroke onset.Results: The mean age of the study population was 61.73±10.49 years, with male predominance. Elevated CRP levels were significantly associated with lower GCS scores, higher NIHSS scores, and increased early mortality. D-dimer, procalcitonin, and CRP demonstrated significant inverse correlations with Scandinavian Stroke Scale scores and positive correlations with Modified Rankin Scale scores at admission and 30-day follow-up. Patients with elevated biomarker levels consistently showed poorer neurological recovery and greater functional disability. CRP-positive patients experienced substantially higher 7-day mortality compared with CRP-negative individuals.Conclusion: Admission plasma D-dimer, serum procalcitonin, and CRP levels were significantly associated with stroke severity, functional disability, and poor short-term outcome in acute ischemic stroke. These biomarkers may provide clinically useful, minimally invasive tools for early prognostic assessment and risk stratification in stroke management.
Keywords: Acute ischemic stroke, D-dimer, Procalcitonin, C-reactive protein, Stroke prognosis
References
Ageno, W., Finazzi, S., Steidl, L., Biotti, M. G., Mera, V., Melzi d’Eril, G., & Venco, A. (2002). Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes. Archives of Internal Medicine, 162(22), 2589–2593. https://doi.org/10.1001/archinte.162.22.2589
Barber, M., Langhorne, P., Rumley, A., Lowe, G. D., & Stott, D. J. (2004). Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression. Stroke, 35(6), 1421–1425. https://doi.org/10.1161/01.STR.0000128230.36440.6c
Black, S., Kushner, I., & Samols, D. (2004). C-reactive protein. Journal of Biological Chemistry, 279(47), 48487–48490. https://doi.org/10.1074/jbc.R400025200
Campbell, B. G., & Zimmerman, R. D. (1998). Emergency magnetic resonance of the brain. Topics in Magnetic Resonance Imaging, 9(4), 208–227.
Emre, U., Durukan, A., & Tatlisumak, T. (2007). Iskemik inmede acil tani ve tedavi yaklasimlari. Turkiye Klinikleri Journal of Surgical Medical Sciences, 3, 6–12.
Grunwald, I., & Reith, W. (2002). Non-traumatic neurological emergencies: Imaging of cerebral ischemia. European Radiology, 12(7), 1632–1647. https://doi.org/10.1007/s00330-001-1222-y
Hasan, N., McColgan, P., Bentley, P., Edwards, R. J., & Sharma, P. (2012). Towards the identification of blood biomarkers for acute stroke in humans: A comprehensive systematic review. British Journal of Clinical Pharmacology, 74(2), 230–240. https://doi.org/10.1111/j.1365-2125.2012.04212.x
Hiltunen, S., Putaala, J., Haapaniemi, E., Salonen, O., & Tatlisumak, T. (2013). D-dimer and clinicoradiologic features in cerebral venous thrombosis. Journal of the Neurological Sciences, 327(1–2), 12–14. https://doi.org/10.1016/j.jns.2013.01.009
Jin, R., Yang, G., & Li, G. (2010). Inflammatory mechanisms in ischemic stroke: Role of inflammatory cells. Journal of Leukocyte Biology, 87(5), 779–789. https://doi.org/10.1189/jlb.1109766
Landi, G., D’Angelo, A., Boccardi, E., Candelise, L., Mannucci, P. M., Nobile Orazio, E., et al. (1987). Hypercoagulability in acute stroke: Prognostic significance. Neurology, 37(10), 1667–1671. https://doi.org/10.1212/WNL.37.10.1667
Lip, G. Y., Blann, A. D., Farooqi, I. S., Zarifis, J., Sagar, G., & Beevers, D. G. (2002). Sequential alterations in haemorheology, endothelial dysfunction, platelet activation and thrombogenesis in relation to prognosis following acute stroke: The West Birmingham Stroke Project. Blood Coagulation & Fibrinolysis, 13(4), 339–347. https://doi.org/10.1097/00001721-200206000-00009
Massaro, K. S., Costa, S. F., Leone, C., et al. (2007). Procalcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infectious Diseases, 7, 137. https://doi.org/10.1186/1471-2334-7-137
Matsumoto, M., Sakaguchi, M., Okazaki, S., Furukado, S., Tagaya, M., Etani, H., & Kitagawa, K. (2013). Relationship between plasma D-dimer level and cerebral infarction volume in patients with nonvalvular atrial fibrillation. Cerebrovascular Diseases, 35(1), 64–72. https://doi.org/10.1159/000345336
Mitchell, B. D., Stern, M. P., Haffner, S. M., Hazuda, H. P., & Patterson, J. K. (1990). Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites: The San Antonio Heart Study. American Journal of Epidemiology, 131(3), 423–433. https://doi.org/10.1093/oxfordjournals.aje.a115515
Montaner, J., Perea-Gainza, M., Delgado, P., Ribó, M., Chacón, P., Rosell, A., Quintana, M., Palacios, M. E., Molina, C. A., Alvarez-Sabín, J., & Arenillas, J. F. (2008). Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke, 39(8), 2280–2287. https://doi.org/10.1161/STROKEAHA.107.505354
Mullins, M. E., Schaefer, P. W., Sorensen, A. G., Halpern, E. F., Ay, H., He, J., et al. (2002). CT and conventional and diffusion-weighted MR imaging in acute stroke: Study in 691 patients at presentation to the emergency department. Radiology, 224(2), 353–360. https://doi.org/10.1148/radiol.2242010501
Omkar Prasad, B., Susmita, C., & Ksh Gomti, D. (2013). Clinico-epidemiological study of acute ischemic stroke in a tertiary hospital of northeastern state of India. International Journal of Biomedical and Advance Research, 4(9), 661–664.
Park, Y. W., Koh, E. J., & Choi, H. Y. (2011). Correlation between serum D-dimer level and volume in acute ischemic stroke. Journal of Korean Neurosurgical Society, 50(2), 89–94. https://doi.org/10.3340/jkns.2011.50.2.89
Rothwell, P. M., Coull, A. J., Giles, M. F., et al. (2004). Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). The Lancet, 363(9425), 1925–1933. https://doi.org/10.1016/S0140-6736(04)16405-2
Scott, A. P., & Barsan, W. G. (1999). Stroke, transient ischemic attack, and other central focal conditions. In J. E. Tintinalli, G. D. Kelen, & J. S. Stapczynski (Eds.), Emergency medicine: A comprehensive study guide (5th ed., pp. 1430–1439). McGraw-Hill.
Shenhar-Tsarfaty, S., Yayon, N., Waiskopf, N., et al. (2015). Fear and C-reactive protein co-synergize annual pulse increases in healthy adults. Proceedings of the National Academy of Sciences of the United States of America, 112(5), E467–E471. https://doi.org/10.1073/pnas.1417603112
Siddique, A., Nur, Z., Mahbub, S., Alam, B., & Miah, T. (2009). Clinical presentation and epidemiology of stroke: A study of 100 cases. Journal of Medicine, 10, 86–89.
Tian, D., Zhang, S., He, X., & Liu, H. (2015). Serum procalcitonin as a diagnostic marker in acute ischemic stroke. NeuroReport, 26(1), 33–37. https://doi.org/10.1097/WNR.0000000000000290
Ufuk, E., Ufuk, E., Aysun, U., Ozlem, C., Tugrul, H., Hulya, Y., Umit, G., & Levent, I. (2007). The role of acute phase reactants in acute ischemic stroke. Journal of Neurological Sciences (Turkish), 24(1), 64–69.
Warlow, C., Dennis, M. S., van Gijn, J., et al. (1996). Stroke: A practical guide to management. Blackwell.
Weinhold, B., Bader, A., Poli, V., & Rüther, U. (1997). Interleukin-6 is necessary, but not sufficient, for induction of the human C-reactive protein gene in vivo. Biochemical Journal, 325(3), 617–621. https://doi.org/10.1042/bj3250617
Wintermark, M., & Bogousslavsky, J. (2003). Imaging of acute ischemic brain injury: The return of computed tomography. Current Opinion in Neurology, 16(1), 59–63. https://doi.org/10.1097/00019052-200302000-00011
Yang, X. Y., Gao, S., Ding, J., Chen, Y., Zhou, X. S., & Wang, J. E. (2014). Plasma D-dimer predicts short-term poor outcome after acute ischemic stroke. PLoS ONE, 9(2), e89756. https://doi.org/10.1371/journal.pone.0089756
Zhang, Z. G., Wang, C., Wang, J., et al. (2015). Prognostic value of mannose-binding lectin: 90-day outcome in patients with acute ischemic stroke. Molecular Neurobiology, 51(1), 230–239. https://doi.org/10.1007/s12035-014-8727-5
Zi, W. J., & Shuai, J. (2014). Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke. PLoS ONE, 9(1), e86465. https://doi.org/10.1371/journal.pone.0086465
Article metrics
View details
0
Downloads
0
Citations
95
Views
0
Save
Save
0
Citation
Citation
95
View
View
0
Share
Share