High plasma D-dimer levels correlate with ictal infarction and poor outcomes in spontaneous subarachnoid hemorrhage

Structured Abstract BACKGROUND Early brain injury (EBI) is the leading cause of poor outcomes in patients with spontaneous subarachnoid hemorrhage (sSAH). Plasma D-dimer levels and acute cerebral ischemia have been highlighted as relevant findings in EBI; however, their correlation has not been substantially investigated. METHODS This retrospective, single-center cohort study was conducted at a tertiary emergency medical center from January 2004 to June 2022. Consecutive patients with sSAH who presented within 12 h of SAH ictus and underwent magnetic resonance imaging within 3 days were included. We assessed the correlation of plasma D-dimer levels with acute ischemic lesions detected on the diffusion-weighted images (DWI) and the clinical characteristics of patients. RESULTS Among 402 eligible patients (mean age, 63.5 years; 62.7% women; median time from onset to arrival, 45.5 min), 140 (34.8%) had acute ischemic lesions. Higher plasma D-dimer levels linearly correlated with worse neurological grades, more severe SAH on initial CT, acute ischemic lesions, and poor outcomes, except for patients with neurogenic stunned myocardium. In the multivariate analysis, acute ischemic lesions were significantly associated with worse neurological grades, higher plasma D-dimer levels, bilateral loss of light reaction, and advanced age. The receiver operating characteristic curve analysis showed D-dimer levels as excellent predictors for acute ischemic lesions (area under the curve [AUC], 0.897; cut-off value, 5.7 µg/mL; p <0.0001) and unfavorable outcomes (AUC, 0.786; cut-off value, 4.0 µg/mL; p <0.0001). CONCLUSIONS High plasma D-dimer levels correlated with the appearance of acute ischemic lesions on DWI and were dose-dependently associated with worse neurological grades, more severe hemorrhage, and worse outcomes. Plasma D-dimer levels provide a valuable perspective on various issues in the acute phase of sSAH.