Examination of usefulness of SF and D-dimer in differentiating ischemic stroke

Abstract

When an emergency patient suspected of having acute-phase cerebral infarction is transported to the emergency room, it is important to diagnose whether he is having a cardioembolic stroke (CE) or a non-cardioembolic stroke (non-CE). Here, using 101 plasma samples derived from such patients who were carried into the emergency center of our hospital from July 2016 to February 2018, we examined the usefulness of the soluble fibrin monomer–fibrinogen complex (SF) or D-dimer measurements during the hospitalization time. Among the 101 patients, 33 had CE and 68 had non-CE. On the basis of interval from the onset to hospitalization [ΔT(hr)], the patients were classified into 2 groups: hyperacute-phase group (ΔT ≤ 4.5) and semiacute-phase group (ΔT > 4.5). Since the SF or D-dimer levels obtained during the hospitalization time did not correlate with the NIH Stroke Scale (NIHSS) or modified Rankin Scale (mRS) score, the SF or D-dimer levels reflected neither the severity on the hospitalization day nor the prognosis on the discharge day. The SF and D-dimer levels in the CE group were significantly higher than those in the non-CE group and not dependent on ΔT. Furthermore, the ROC analysis showed that the highest AUC value was obtained when the SF level in the hyperacute phase was selected as a variable (cut off value, 11.8 μg/mL; AUC, 0.92; specificity, 97%; sensitivity, 87%). We thus concluded that SF determination in the hyperacute phase could be a useful tool for differentiating patients with CE from those with non-CE.