• Hitoshi Kobata, Akira Sugie, Adam Tucker, Gemmalynn Sarapuddin, Hitomi Kimura, Hitoshi Takeshita, Munenori Morihara, and Makiko Kawakami.
• Department of Neurosurgery, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan; Department of Neurosurgery/Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. Electronic address: hitoshi.kobata@ompu.ac.jp.
• World Neurosurg. 2024 Oct 1; 190: e809e822e809-e822.

BackgroundEarly brain injury is the leading cause of poor outcomes in spontaneous subarachnoid hemorrhage (sSAH). Plasma D-dimer levels and acute cerebral ischemia have been highlighted as relevant findings in early brain injury; however, their correlation has not been substantially investigated.MethodsThis 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 hours of 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 imageing and the clinical characteristics.ResultsAmong 402 eligible patients (mean age, 63.5 years; 62.7% women; median time from onset to arrival, 45.5 minutes), 140 (34.8%) had acute ischemic lesions. Higher plasma D-dimer levels linearly correlated with worse neurological grades, more severe SAH on initial computed tomography, 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, 0.897; cut-off value, 5.7 μg/mL; P<0.0001) and unfavorable outcomes (area under the curve, 0.786; cut-off value, 4.0 μg/mL; P<0.0001).ConclusionsHigh plasma D-dimer levels correlated with the appearance of acute ischemic lesions on diffusion-weighted imaging and were dose-dependently associated with worse neurological grades, more severe hemorrhage, and worse outcomes.Copyright © 2024 Elsevier Inc. All rights reserved.

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