Changes And Clinical Significance Of D-Dimer In Progressive Hemorrhagic Injury After Traumatic Brain Injury

Objective:The goal of this study was to describe and validate the relationship between D-dimer values and progressive hemorrhagic injury(PHI) in traumatic brain injury(TBI),and to investigate risk factors for PHI.Methods:The medical records of traumatic brain injury patients admitted to our department of neurosurgery were retrospectively reviewed.A series of clinical parameters were recorded including gender,age,injury mechanism,timing from injury to the first CT scanning,systolic pressure,Glasgow Coma Scale(GCS),prothrombin time(PT),activated partial thromboplastin time(APTT),plasma fibrinogen(Fg) values,plasma D-dimer values at admission and Glasgow Outcome Score(GOS) at discharge.A logistic multiple regression analysis was used to identify the risk factors of PHI.Use receiver operating characteristic curve(ROC) to infer the relationship between D-dimer level and the occurrence of PHI.Results:A cohort of 121 closed head injury patients was evaluated in this clinical study. The male patients suffered a predominant difference to the famine.There was statistic significance in the relevance between PHI and age,with which mean was 44,showing PHIs were older.Most patients were hurt in traffic accidents and also no relation to PHI was found.84 patients admitted within 2 hours after injury,and with a meantime of 2.07±1.67 hours,patients performed their first CT scan earlier had a higher PHI possibility. Eight developed PHI in 11 patients whose systolic blood pressure lower than 90mmHg,the threshold of hypotension which indicated tending to progressive(OR=3.85,P=0.043). There was no difference in different GOS groups.And interestingly,PHI was relevant to abnormal PT while no significance in longer APTT patients was found.PHI correlated with lower PLT and Fg.Leision type showed no significance either.Eighty percent PHI sufferers needed surgical evacuation with mortality of 43.4%,higher than non-PHIs(P＜ 0.01).Logistic regression analysis showed that timing of the first CT scan (P=0.016),Glasgow Coma Scale(GCS)(P＜0.01),PLT count(P=0.013),and D-dimer value(P=0.001) were relative to injury seemed to be predictors of PHI.D-dimer values elevated in most patients.There were no difference among hematoma lesions(χ~2=5.077,P=0.166).Patients with poor outcome had higher D-dimer values than did those with favorable outcome(P＜0.01),following negative relevance(Spearman's rho=-0.632,P＜0.01).Receiver operating characteristic curve(ROC) indicated that the cutoff point was 5.00mg/L,with sensitivity and specificity of 72%and 71%,respectively.Conclusion:It can be concluded that PHI was induce by multiple factors including age,timing from injury to the first CT scanning,systolic pressure,Glasgow Coma Scale (GCS),plasma fibrinogen(Fg) values and plasma D-dimer values at admission.Especially, plasma D-dimer values could be regarded as a prognostic factor to PHI,seemingly higher risk of PHI accompanied with higher D-dimer value.Much attention should be paid to patients present remarkable D-dimer values,while serial CT scanning had been considered as an effective way.It can be recommended that patients evolved in the former illustrated circumstances,specifically with dramatic D-dimer level,should receive CT scanning repeatedly.