Abstract
BackgroundPneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer. The aim of our study was to investigate the prognostic value of D-dimer for predicting clinical outcome of AF-related AIS with pneumonia.MethodAF-related AIS patients with pneumonia were prospectively enrolled. Receiver operating characteristic (ROC) curve was used to determine the optimal D-dimer point for 3-month mortality and death/severe disability. The associations between the D-dimer and 3-month mortality and death/severe disability were assessed by multivariable logistic regression analysis.ResultsA total of 415 patients were enrolled in this study. ROC curve analysis showed that the optimal cut point of D-dimer for 3-month death/severe disability and mortality were D-dimer≥2.35 mg/l and D-dimer≥3.35 mg/l, respectively. Multivariable logistic regression analysis showed that D-dimer≥2.35 mg/l [adjusted odds ratio (aOR) 5.99, 95% confidence interval (CI): 3.04–11.83, P<0.001], higher NIHISS score (aOR:1.53, 95% CI: 1.38–1.69, P<0.001) and larger infarct volume (aOR 1.01, 95% CI: 1.01–1.02, P<0.001) were associated with increased risk of 3-month death/severe disability), and anticoagulant was associated with decreased risk of death/severe disability (aOR:0.21, 95% CI: 0.09–0.47, P<0.001). Higher NIHISS score (aOR:1.64, 95% CI: 1.38–1.94, P<0.001), older age (aOR 1.08, 95% CI: 1.02–1.14, P = 0.007), D-dimer≥3.35 mg/l (OR 8.49, 95% CI: 4.13–17.84,P<0.001), larger infarct volume (aOR 1.02, 95% CI: 1.00–1.03, P = 0.014), and higher CRUB-65 score (aOR 6.43, 95% CI: 3.10–13.34, P<0.001) were associated with increased risk of 3-month mortality.ConclusionsAF-related AIS patients with concurrent high D-dimer and pneumonia increased risk of 3-month mortality and death/severe disability, plasma D-dimer may have predictive value in outcome after AF-related AIS with pneumonia.
Highlights
Pneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer
Multivariable logistic regression analysis showed that D-dimer≥2.35 mg/l [adjusted odds ratio 5.99, 95% confidence interval (CI): 3.04–11.83, P
Higher NIHISS score, older age, D-dimer≥3.35 mg/l, larger infarct volume, and higher CRUB-65 score were associated with increased risk of 3-month mortality
Summary
Pneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer. Atrial fibrillation (AF) is the most common arrhythmia, which associated with increased risk of mortality and disability after stroke. Studies had showed that patients with AF could increase D-dimer levels [7,8,9], and higher Ddimer levels could increase risk of future cerebrovascular and cardiovascular events [10,11,12], increased D-dimer levels had been reported to be proportional to the severity of stroke. Pneumonia is the most common complication of AIS, which could lead to poor clinical outcomes and increase mortality, previous study had showed a significant correlation between D-dimer levels and pneumonia severity, and higher D-dimer levels in patients with pneumonia could identify individuals at increased risk for in-hospital death [17]. Studies had showed that elevated D-Dimer was associated with major complications during hospitalization in patients with pneumonia [18, 19]
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