A Systematic Review of the Predictive Value of Plasma D-Dimer Levels for Predicting Stroke Outcome

Abstract

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.