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The Association Between D-dimer Levels and Long-Term Neurological Outcomes of Patients with Traumatic Brain Injury: An Analysis of a Nationwide Observational Neurotrauma Database in Japan

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Abstract

Background

We evaluated the association between D-dimer (DD) levels and long-term neurological prognoses among patients with isolated traumatic brain injury.

Methods

Using data from multiple centers in the Japanese Neurotrauma Data Bank, we conducted an observational retrospective cohort study. Patients with isolated traumatic brain injury (head Abbreviated Injury Scale score > 2; any other Abbreviated Injury Scale score < 3) who were registered in the Japanese Neurotrauma Data Bank from 2015 to 2017 were recruited. We excluded patients younger than age 16 years and those who developed cardiac arrest at hospital admission. We also excluded patients with unknown Glasgow Outcome Scale (GOS) scores at 6 months after injury and those with unknown DD levels. The primary outcome was the association of DD levels with GOS scores at 6 months. We defined GOS scores 1 to 3 as poor and GOS scores 4 and 5 as good. The secondary outcome was the association of DD levels with mortality at 6 months after injury. We conducted multivariate logistic regression analyses to calculate the adjusted odds ratios of DD levels at hospital admission and GOS scores at 6 months as tertiles with 95% confidence intervals (CIs). A total of 293 patients were enrolled (median age 67 years; interquartile range 51–79 years). The median DD level was 27.1 mg/L (interquartile range 9.7–70.8 mg/L), and 58.0% (n = 170) had poor GOS scores at 6 months.

Results

The multivariable logistic regression analysis indicated that the adjusted odds ratios were 2.52 (95% CI 1.10–5.77) for middle DD levels with poor GOS scores at 6 months and 5.81 (95% CI 2.37–14.2) for high DD levels with poor GOS scores at 6 months.

Conclusions

We revealed an association between DD levels and poor long-term neurological outcomes among patients with isolated traumatic brain injury.

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Change history

  • 06 September 2021

    This article was updated to remove extraneous letters from the column headings in Table 1.

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Acknowledgements

Institutions registered in the multicenter registry are as follows: Sapporo Medical University Hospital, Aomori Prefectural Central Hospital, Sendai City Hospital, Shinshu Ueda Medical Center, Chiba Emergency Medical Center, Chiba University Hospital, Kimitsu Chuo Hospital, The Jikei University Kashiwa Hospital, Showa University Hospital, Teikyo University Hospital, Nippon Medical School Hospital, Nihon University Hospital, National Disaster Medical Center, National Defense Medical College Hospital, Yokohama City University Medical Center, St. Marianna University Hospital, Tokai University Hospital, Toho University Medical Center Ohashi Hospital, Nippon Medical School Tama Nagayama Hospital, Tokyo Medical and Dental University Hospital, Nagoya City University Hospital, Saiseikai Shiga Hospital, Kyoto Kujo Hospital, Nara Medical University Hospital, Osaka Mishima Emergency Critical Care Center, Hyogo Prefectural Kakogawa Medical Center, Kagawa University Hospital, Yamaguchi University Hospital, Iizuka Hospital, Kurume University Hospital, Fukuoka University Hospital, and the Japanese Red Cross Kumamoto Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Gaku Fujiwara & Naoya Hashimoto

  2. Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan

    Yohei Okada

  3. Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan

    Takehiko Sakakibara & Tarumi Yamaki

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  1. Gaku Fujiwara
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  2. Yohei Okada
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  4. Tarumi Yamaki
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  5. Naoya Hashimoto
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Contributions

Conception and design of the work: GF. Data acquisition: TS. Analysis: GF, YO. Interpretation : GF, YO. Writing the draft: GF. Editing, supervising: YO, TS, TY, NH.

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Fujiwara, G., Okada, Y., Sakakibara, T. et al. The Association Between D-dimer Levels and Long-Term Neurological Outcomes of Patients with Traumatic Brain Injury: An Analysis of a Nationwide Observational Neurotrauma Database in Japan. Neurocrit Care 36, 483–491 (2022). https://doi.org/10.1007/s12028-021-01329-7

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