A Retrospective Cohort Study on a Novel Marker to Predict the Severity and Prognosis of Acute Cerebral Venous Thrombosis: D-dimer to Fibrinogen Ratio

Overview

Journal Thromb J

Publisher Biomed Central

Date 2024 Oct 31

PMID 39478537

Authors

Duo Lan

Mengqi Wang

Xiaoming Zhang

Xiangqian Huang

Naiqi Liu

Xiangyu Ren

Kun Fang

Da Zhou

Ran Meng

Affiliations

Soon will be listed here.

Abstract

Background And Aim: The D-dimer to fibrinogen ratio (DFR) represents an emerging and significant clinical biomarker. However, its correlation with cerebral venous thrombosis (CVT) remains underexplored. This retrospective cohort study aims to elucidate the association between DFR values and the severity and prognosis of CVT.

Methods: Severe CVT was defined as the presence of at least 1 of the following risk factors: mental status disorder, coma state, intracranial cerebral hemorrhage, or thrombosis of the deep cerebral venous system. The modified Rankin Scale was utilized to assess functional outcomes. DFR measurements were obtained within 24 h of hospital admission. Logistic regression analysis was employed to determine the prognostic significance of DFR. After Bonferroni correction, a two-tailed P value < 0.017 (0.05/3) was considered statistically significant.

Result: A total of 196 patients were included in the study, among whom 85 patients were diagnosed with severe CVT, and 35 and 14 patients experienced short-term and long-term adverse outcomes, respectively. Receiver operating characteristic curve analysis demonstrated that DFR has predictive value for severe CVT, poor short-term and long-term outcomes, with area under the curve values of 0.690 [95% CI: 0.617-0.764, P < .001], 0.773 [95% CI: 0.701-0.845, P < .001], and 0.754 [95% CI: 0.619-0.886, P = .002], respectively. DFR ≥ 0.253 was identified as a significant predictor of severe CVT [adjusted odds ratio (aOR) (95% CI): 2.03 (1.10-3.75), P = .024]. Additionally, DFR ≥ 0.322 and DFR ≥ 0.754 were significantly associated with poor short-term outcomes at discharge [aOR (95% CI): 2.63 (1.43-4.76), P = .002] and poor long-term outcomes at 12 months [aOR (95% CI): 2.86 (1.32-6.25), P = .008], respectively.

Conclusion: Elevated DFR is associated with increased severity of CVT. Additionally, higher DFR levels can predict poorer clinical outcomes in CVT.

References

Wuillemin W, Korte W, Waser G, Lammle B . Usefulness of the D-dimer/fibrinogen ratio to predict deep venous thrombosis. J Thromb Haemost. 2005; 3(2):385-7. DOI: 10.1111/j.1538-7836.2004.01121.x. View

Liu F, Liu X, He Y, Liu G, Lan T, Ye J . Clinical value of GRACE score combined with DFR in predicting short-term prognosis of patients undergoing early PCI after thrombolysis for acute myocardial infarction. Eur Rev Med Pharmacol Sci. 2023; 27(9):4038-4045. DOI: 10.26355/eurrev_202305_32309. View

Crassard I, Soria C, Tzourio C, Woimant F, Drouet L, Ducros A . A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients. Stroke. 2005; 36(8):1716-9. DOI: 10.1161/01.STR.0000173401.76085.98. View

Ferro J, Bousser M, Canhao P, Coutinho J, Crassard I, Dentali F . European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017; 24(10):1203-1213. DOI: 10.1111/ene.13381. View

Xu D, Du W, Li X, Wu Z, Yu G . D-dimer/fibrinogen ratio for the prediction of progressive hemorrhagic injury after traumatic brain injury. Clin Chim Acta. 2020; 507:143-148. DOI: 10.1016/j.cca.2020.04.022. View

Ropper A, Klein J . Cerebral Venous Thrombosis. N Engl J Med. 2021; 385(1):59-64. DOI: 10.1056/NEJMra2106545. View

Bai Y, Zheng Y, Tang J, Yang X, Guo Q, Zhang J . D-Dimer to Fibrinogen Ratio as a Novel Prognostic Marker in Patients After Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study. Clin Appl Thromb Hemost. 2020; 26:1076029620948586. PMC: 7453438. DOI: 10.1177/1076029620948586. View

Kara H, Bayir A, Degirmenci S, Kayis S, Akinci M, Ak A . D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department. Acta Clin Belg. 2014; 69(4):240-5. DOI: 10.1179/2295333714Y.0000000029. View

Shorr A, Thomas S, Alkins S, Fitzpatrick T, Ling G . D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest. 2002; 121(4):1262-8. DOI: 10.1378/chest.121.4.1262. View

10.

Lalive P, de Moerloose P, Lovblad K, Sarasin F, Mermillod B, Sztajzel R . Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis?. Neurology. 2003; 61(8):1057-60. DOI: 10.1212/01.wnl.0000090562.66120.1f. View

11.

Hashami L, Rakhshan V, Karimian H, Moghaddasi M . Diagnostic Value of D-Dimer's Serum Level in Iranian Patients with Cerebral Venous Thrombosis. Neurol Int. 2016; 8(2):6310. PMC: 4935813. DOI: 10.4081/ni.2016.6310. View

12.

Borowiec A, Dabrowski R, Kowalik I, Rusinowicz T, Hadzik-Blaszczyk M, Krupa R . Elevated levels of d-dimer are associated with inflammation and disease activity rather than risk of venous thromboembolism in patients with granulomatosis with polyangiitis in long term observation. Adv Med Sci. 2020; 65(1):97-101. DOI: 10.1016/j.advms.2019.12.007. View

13.

Luo S, Yang W, Shen Y, Chen P, Zhang S, Jia Z . The clinical value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and D-dimer-to-fibrinogen ratio for predicting pneumonia and poor outcomes in patients with acute intracerebral hemorrhage. Front Immunol. 2022; 13:1037255. PMC: 9589455. DOI: 10.3389/fimmu.2022.1037255. View

14.

Saposnik G, Barinagarrementeria F, Brown Jr R, Bushnell C, Cucchiara B, Cushman M . Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42(4):1158-92. DOI: 10.1161/STR.0b013e31820a8364. View

15.

Wang L, Duan J, Bian T, Meng R, Wu L, Zhang Z . Inflammation is correlated with severity and outcome of cerebral venous thrombosis. J Neuroinflammation. 2018; 15(1):329. PMC: 6260678. DOI: 10.1186/s12974-018-1369-0. View

16.

Wen H, Wang N, Hou R . Correlation analysis between D-dimer-to-fibrinogen-ratio and carotid plaque in young patients aged 18-45 with acute cerebral infarction. Clin Neurol Neurosurg. 2022; 222:107427. DOI: 10.1016/j.clineuro.2022.107427. View

17.

Coutinho J, Zuurbier S, Bousser M, Ji X, Canhao P, Roos Y . Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol. 2020; 77(8):966-973. PMC: 7235912. DOI: 10.1001/jamaneurol.2020.1022. View

18.

Alons I, Jellema K, Wermer M, Algra A . D-dimer for the exclusion of cerebral venous thrombosis: a meta-analysis of low risk patients with isolated headache. BMC Neurol. 2015; 15:118. PMC: 4517419. DOI: 10.1186/s12883-015-0389-y. View

19.

Izuegbuna O, Agodirin O, Olawumi H, Olatoke S . Plasma D-Dimer and Fibrinogen Levels Correlates with Tumor Size and Disease Progression in Nigerian Breast Cancer Patients. Cancer Invest. 2021; 39(8):597-606. DOI: 10.1080/07357907.2021.1909059. View

20.

Ma X, Ji X, Fu P, Ding Y, Xue Q, Huang Y . Coexistence of High Fibrinogen and Low High-density Lipoprotein Cholesterol Levels Predicts Recurrent Cerebral Venous Thrombosis. Chin Med J (Engl). 2015; 128(13):1732-7. PMC: 4733709. DOI: 10.4103/0366-6999.159345. View