Study On The Association Of The Plasma D-Dimer,Fibrin(Ogen) Degradation Products And Their Ratios Level With Prognosis After Acute Cerebral Infarction In Patients Who Received Intravenous Thrombolysis Therapy

Objective To investigate the association of the plasma D-dimer(D-D),fibrin(ogen)degradation products(FDP)and D-D/FDP level with short-term prognosis and poor functional outcome at 3 months after acute ischemic stroke(AIS)in patients who received intravenous thrombolysis therapy(IVT).Methods The study included 422 AIS patients with IVT in Affiliated Hospital of Nantong University from January 2020 to December 2021.Recorded the clinical data at3 months after stroke.The primary outcome was the poor functional outcome,which is the combination of death and major disability(modified Rankin Scale score: 3-6)within3 months after stroke.The secondary outcome was early neurological deterioration.The secondary outcome was that the NIHSS of AIS patients increased 5 points from the admission to discharge,including in-hospital mortality,indicating poor short-term prognosis.Multivariate logistic regression models was used to analyze the strength of the association of the plasma D-D,FDP and D-D/FDP level with the primary end-point and the secondary end-point after AIS.Finally,ROC curve was used to analyze the predictive value of plasma D-D,FDP and D-D/FDP for the primary end-point and the secondary end-point after AIS.Results1.Compared with patients without the combination of death and major disability,plasma D-D,FDP and D-D/FDP levels of AIS patients with the combination of death and major disability were significantly increased within 3 months 0.96(0.505-2.24)VS 0.475(0.23-0.94).P < 0.001,3.0(1.8-6.0)VS 1.8(1.1-2.7),P < 0.001 and 0.32(0.245-0.400)VS 0.27(0.21-0.353),P< 0.001.Compared with patients without poor short-term prognosis,plasma D-D/FDP levels in AIS patients with poor short-term prognosis were significantly higher 0.305(0.250-0.420)VS 0.28(0.21-0.37),P =0.021.However,Plasma D-D and FDP levels of patients showed no significant difference in poor short-term prognosis after AIS.2.Ordinal logistic regression analyses showed a significantly worse shift in the distribution of m RS scores with higher plasma D-D,FDP and D-D/FDP tertiles level in AIS patients(OR: 2.17,95% CI: 1.73-2.71),(OR: 2.13,95% CI: 1.71-2.65)and(OR:1.55,95% CI: 1.25-1.92),all P < 0.001.3.After adjusting for multivariate risk factors,patients in the highest tertile of plasma D-D,FDP,and D-D/FDP had a higher risk of poor functional outcomes than patients in the lowest tertile of plasma D-D,FDP,and D-D/FDP,respectively(OR:3.65,95% CI:1.95-6.85,P <0.001),(OR:3.68,95%CI : 1.99-6.81,P <0.001)and(OR: 1.84,95%CI:1.04-3.27,P =0.037).After adjusting for multivariate risk factors,patients in the highest tertile of plasma D-D,FDP,and D-D/FDP,respectively,patients in the highest tertile of plasma D-D/FDP had a higher risk of early neurological deterioration(OR: 3.40,95%CI:1.40-8.18,P=0.007).Increased plasma D-D and FDP levels did not significantly increase the risk of early neurological deterioration(OR:1.46,95%CI: 0.61-3.52,P =0.4)and(OR:0.81,95%CI: 0.35-1.90,P =0.629).4.The area of ROC curve of plasma D-D,FDP and D-D/FDP to predict the combination of death and major disability at 3 months after AIS was 0.705,0.698 and0.619,respectively,and the sensitivity was 66.5%,83.2% and 57.8%,respectively.The specificity was 66.1%,46.9% and 62.2%,respectively(all P < 0.001).The area of ROC curve of plasma D-D,FDP and D-D/FDP to predict poor short-term prognosis after AIS was 0.533,0.491 and 0.604,respectively,and the sensitivity was 93.5%,95.7% and89.1%.The specificity was 19.5%,13.0% and 28.5%,respectively(P values were 0.463,0.85 and 0.021).5.Adding plasma D-D,FDP and D-D/FDP to the traditional model can significantly improve the prediction of poor functional outcomes at 3 months after AIS(NRI:4%,95%CI: 1%-7%,P=0.016.IDI: 1%,95% CI: 0%-2.0%,P=0.031)、(NRI:26%,95% CI:8%-44%,P=0.003.IDI: 1%,95% CI: 0%-2%,P=0.041)and(NRI: 30%,95% CI:11%-50%,P=0.002.IDI: 0%,95% CI: 0%-2%,P=0.078),respectively.Adding plasma D-D,FDP and D-D/FDP to the traditional model respectively,plasma D-D/FDP could significantly improve the prediction of early neurological deterioration after AIS.(NRI:26%,95% CI:-4%-20%,P=0.09.IDI:3%,95% CI: 1%-6%,P=0.018),the net reclassification index for predicting poor functional outcomes was significantly increased.However,the ability of plasma D-D and FDP to predict early neurological deterioration was not significantly improved(NRI:-3%,95% CI:-10%-5%,P=0.47.IDI: 0%,95%CI:-0.1%-0%,P=0.76)and(NRI:0.2%,95% CI:-0.7%-1%,P=0.56.IDI: 0%,95% CI:-0.1%-0.2%,P=0.81).Conclusion In patients of AIS receiving intravenous thrombolysis therapy,increased plasma D-D,FDP and D-D/FDP levels were positively correlated with the combination of death and major disability at 3 months after AIS.The patients of poor short-term prognosis after AIS was positively correlated with the plasma D-D/FDP,but it don`t correlated with plasma D-D and FDP.The ability of plasma D-D and FDP to predict the combination of death and major disability at 3 months after AIS is better than the plasma D-D/FDP,and plasma D-D/FDP maybe has predictive value for short-term prognosis after AIS.