D-dimer Levels and Cerebral Infarction in Critically Ill Cancer Patients

Background: D-dimer levels have been used in the diagnosis of a variety of thrombosis-related diseases. In this study, we evaluated whether measuring D-dimer levels can help to diagnose cerebral infarction (CI) in critically ill cancer patients. Methods: We retrospectively evaluated all patients with malignancies who underwent brain magnetic resonance imaging (MRI) between March 2010 and February 2014 at the medical oncology intensive care unit (ICU) of Samsung Medical Center. Brain MRI scanning was performed when CI was suspected due to acute neurological deficits. We compared D-dimer levels between patients ultimately diagnosed as having or not having CI and analyzed diffusion-weighted imaging (DWI) lesion patterns. Results: A total of 88 patients underwent brain MRI scanning due to clinical suspicion of CI; altered mental status and unilateral hemiparesis were the most common neurological deficits. CI was ultimately diagnosed in 43 (49%) patients. According to the DWI patterns, multiple arterial infarctions (40%) were more common than single arterial infarctions (9%). Cryptogenic stroke etiologies were more common (63%) than determined etiologies. There was no significant difference in D-dimer levels between patients with and without CI (P = 0.319). Although D-dimer levels were not helpful in diagnosing CI, D-dimer levels were associated with cryptogenic etiologies in critically ill cancer patients; D-dimer levels were higher in the cryptogenic etiology group than in the determined etiology group or the non-infarction group (P = 0.001). In multivariate analysis, elevated D-dimer levels (> 8.89 μg/mL) were only associated with cryptogenic stroke (adjusted OR 5.455; 95% confidence interval, 1.876 – 15.857). Conclusions: Abnormal D-dimer levels may support the diagnosis of cryptogenic stroke in critically ill cancer patients.

背景：D-二聚体(D-dimer)已被用于多种血栓相关性疾病的诊断。本研究旨在评估检测D-二聚体水平是否有助于诊断重症癌症患者的脑梗死(CI)。
方法：本研究回顾性分析了2010年3月至2014年2月期间，三星医疗中心肿瘤内科重症监护病房(ICU)中所有接受脑部磁共振成像(MRI)检查的恶性肿瘤患者。当患者因急性神经功能缺损疑似脑梗死时，即行脑部MRI扫描。本研究比较了最终确诊为脑梗死与未确诊脑梗死患者的D-二聚体水平，并分析了弥散加权成像(DWI)的病灶模式。
结果：共计88例患者因临床疑似脑梗死接受脑部MRI扫描，其中最常见的神经功能缺损表现为意识状态改变与单侧偏瘫。最终43例（49%）患者确诊为脑梗死。根据弥散加权成像病灶模式，多发性动脉梗死（40%）较单一动脉梗死（9%）更为常见。隐源性卒中病因占比（63%）高于明确病因组。伴与不伴脑梗死患者的D-二聚体水平无显著差异（P=0.319）。尽管D-二聚体水平对脑梗死的诊断无辅助价值，但在重症癌症患者中，D-二聚体水平与隐源性卒中病因存在关联：隐源性病因组患者的D-二聚体水平高于明确病因组或非梗死组（P=0.001）。多因素分析显示，D-二聚体水平升高（>8.89 μg/mL）仅与隐源性卒中相关（校正比值比(adjusted OR) 5.455；95%置信区间(95% confidence interval)：1.876–15.857）。
结论：异常D-二聚体水平可辅助诊断重症癌症患者的隐源性卒中。