Key result
Elevated D-dimer linked to poor acute ischaemic stroke outcomes with ~96% diagnostic accuracy.
Why the study?
Timely neurological stratification in acute ischaemic stroke is critical but often limited by delayed radiological access, necessitating alternative predictive biomarkers.
Does admission plasma D-dimer measurement accurately predict poor neurological outcomes in patients with acute ischaemic stroke?
Cross-Sectional (n=321)
No
Does admission plasma D-dimer measurement accurately predict poor neurological outcomes in patients with acute ischaemic stroke?
Effect estimate: Sensitivity 87.50%, Specificity 96.39%, PPV 56.00%, NPV 99.32%, Accuracy 95.95%
Plasma D-dimer ≥310 ng/mL is an inexpensive and rapid biomarker with exceptionally high negative predictive value (99.32%) for ruling out severe neurological deficits in acute ischaemic stroke, offering a reliable triage tool for resource-limited settings.
May support D-dimer for early prognostication in acute ischaemic stroke; hypothesis-generating and requires validation before practice change.
Introduction: Acute ischaemic stroke (AIS) is a leading cause of death and disability worldwide. Timely neurological stratification is critical but often limited by delayed radiological access. Plasma D-dimer, a fibrin degradation product reflective of coagulation activity, has emerged as a promising, inexpensive biomarker for stroke severity prediction. Objective: To determine the predictive accuracy of plasma D-dimer levels in predicting poor neurological outcomes in AIS, using the National Institutes of Health Stroke Scale (NIHSS) as the gold standard. Study Design: Prospective cross-sectional study. Setting: Department of Medicine, Mayo Hospital (King Edward Medical University), Lahore, Pakistan. Duration: December 2, 2023 to June 2, 2024. Methods: Three hundred and twenty-one consecutive patients with first-episode AIS presenting within 24 hours were enrolled using non-probability consecutive sampling. Plasma D-dimer (threshold ≥310 ng/mL) was measured at admission. NIHSS was used to classify stroke severity. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were calculated. Stratified analyses were performed by age group and gender. Results: The mean age was 52.63 ± 12.89 years. Males comprised 54.21% (n=174). Mean NIHSS was 8.74 ± 8.34. Against NIHSS-defined severe outcome (n=16), D-dimer achieved: sensitivity 87.50%, specificity 96.39%, PPV 56.00%, NPV 99.32%, and accuracy 95.95%. Stratified analyses demonstrated consistently high specificity (≥93%) across all age groups and genders, with highest sensitivity in the 61–70 age group (100%) and in females (90.0%). Conclusion: Elevated plasma D-dimer (≥310 ng/mL) is a diagnostically accurate, low-cost biomarker for identifying poor neurological outcomes in AIS. Its exceptionally high NPV (99.32%) makes it a reliable rule-out tool in resource-limited settings
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Akhtar et al. (2026) conducted a cross-sectional in Acute ischaemic stroke (n=321). Elevated plasma D-dimer (≥310 ng/mL) vs. Plasma D-dimer <310 ng/mL was evaluated on Poor neurological outcome defined as NIHSS ≥16 (Sensitivity 87.50%, Specificity 96.39%, PPV 56.00%, NPV 99.32%, Accuracy 95.95%). Elevated plasma D-dimer (≥310 ng/mL) accurately identified poor neurological outcomes in acute ischaemic stroke, achieving 95.95% diagnostic accuracy, 87.50% sensitivity, and 99.32% NPV.
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