Skip to main content
Log in

D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury

  • Article
  • Published:
Spinal Cord Submit manuscript

Abstract

Study design

Retrospective cohort study.

Objectives

To evaluate the predictive value of D-dimer/fibrinogen (D/F) ratio for deep vein thrombosis (DVT) in patients with traumatic spinal cord injury (SCI).

Setting

Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University.

Methods

SCI patients within 24 h of trauma were consecutively enrolled. DVT was diagnosed by DUS examination during hospitalization. Multivariable logistic regression analysis was performed to determine the relationship between D/F ratio and DVT. Stratified logistic regression analysis was performed to identify effect modifiers. The receiver operating characteristic (ROC) curve was conducted to assess the predictive value of D/F ratio.

Results

A total of 284 patients with SCI were included, of whom 106 (37.3%) developed DVT. D/F ratio was positively correlated with DVT (OR 1.17, 95% confidence interval [CI] 1.04–1.31, p = 0.009). Patients in the upper D/F ratio tertile (3.15–18.27) had a higher risk of DVT than patients in the lower tertile (0.08–0.97) after adjustment for potential confounders (OR 6.01, 95% CI 2.24–16.15, p < 0.001). The risk of DVT increased stepwise across D/F ratio tertiles (p for trend = 0.003). The area under the ROC curve (AUC) was 0.758 (95% CI 0.704–0.806). There was a significant interaction between D/F ratio and neurological level of injury (p for interaction = 0.003) and the association between D/F ratio and DVT remained significant only in patients with cervical injury.

Conclusions

A higher D/F ratio was independently associated with a higher risk of DVT in a dose-dependent manner in patients with cervical SCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2: The multiple spline regression analysis to investigate the relationship between D/F ratio and DVT.
Fig. 3
Fig. 4: Stratified logistic regression analysis to identify variables that modify the relationship between D/F ratio and DVT.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N. Engl J Med. 1994;331:1601–6.

    Article  CAS  PubMed  Google Scholar 

  2. Waring WP, Karunas RS. Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease. Paraplegia 1991;29:8–16.

    CAS  PubMed  Google Scholar 

  3. Gündüz S, Oğur E, Möhür H, Somuncu I, Açjksöz E, Ustünsöz B. Deep vein thrombosis in spinal cord injured patients. Paraplegia 1993;31:606–10.

    PubMed  Google Scholar 

  4. Rathore MF, Hanif S, New PW, Butt AW, Aasi MH, Khan SU. The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005. Spinal Cord. 2008;46:523–6.

    Article  CAS  PubMed  Google Scholar 

  5. Powell M, Kirshblum S, O'Connor KC. Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission. Arch Phys Med Rehabil. 1999;80:1044–6.

    Article  CAS  PubMed  Google Scholar 

  6. Myllynen P, Kammonen M, Rokkanen P, Böstman O, Lalla M, Laasonen E. Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with nonparalyzed patients immobilized due to spinal fractures. J Trauma. 1985;25:541–3.

    Article  CAS  PubMed  Google Scholar 

  7. Alabed S, Belci M, Van Middendorp JJ, Al Halabi A, Meagher TM. Thromboembolism in the sub-acute phase of spinal cord injury: a systematic review of the lite. Asian Spine J. 2016;10:972–81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Saraf SK, Rana RJ, Sharma OP. Venous thromboembolism in acute spinal cord injury patients. Indian J Orthop. 2007;41:194–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Do JG, Kim du H, Sung DH. Incidence of deep vein thrombosis after spinal cord injury in Korean patients at acute rehabilitation unit. J Korean Med Sci. 2013;28:1382–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tripodi A. D-dimer testing in laboratory practice. Clin Chem. 2011;57:1256–62.

    Article  CAS  PubMed  Google Scholar 

  11. van Es N, van der Hulle T, van Es J, den Exter PL, Douma RA, Goekoop RJ, et al. Wells rule and d-Dimer testing to rule out pulmonary embolism: a systematic review and individual-patient data meta-analysis. Ann Intern Med. 2016;165:253–61.

    Article  PubMed  Google Scholar 

  12. Zhang J, Fang Y, Pang H, Tao Y, Zhou J, Zhu S, et al. Association of age-adjusted D-dimer with deep vein thrombosis risk in patients with spinal cord injury: a cross-sectional study. Spinal Cord. 2022;60:90–8.

    Article  PubMed  Google Scholar 

  13. Mackiewicz-Milewska M, Cisowska-Adamiak M, Pyskir J, Świątkiewicz I. Usefulness of D-dimer and ultrasonography screening for detecting deep vein thrombosis in patients with spinal cord injury undergoing rehabilitation. J Clin Med. 2021;10:689.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ma J, Du P, Qin J, Zhou Y, Liang N, Hu J, et al. Incidence and risk factors predicting deep venous thrombosis of lower extremity following spinal fractures. Sci Rep. 2021;11:2441.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kumagai G, Wada K, Kudo H, Asari T, Ichikawa N, Ishibashi Y. D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury. J Spinal Cord Med. 2020;43:353–7.

    Article  PubMed  Google Scholar 

  16. Cho JH, Kim JB, Lee DG. Correlation between D-Dimer level and deep venous thrombosis in patients with acute spinal cord injuries. Am J Phys Med Rehabil. 2020;99:613–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Masuda M, Ueta T, Shiba K, Iwamoto Y. D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries. Spine J. 2015;15:2338–44.

    Article  PubMed  Google Scholar 

  18. Marcianò T, Franchini S. Could a D-dimer/fibrinogen ratio have a role in ruling-out venous thromboembolism? Emerg Med J. 2022;39:941–4.

  19. Kucher N, Kohler HP, Dornhöfer T, Wallmann D, Lämmle B. Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embolism: a prospective diagnostic study. J Thromb Haemost. 2003;1:708–13.

    Article  CAS  PubMed  Google Scholar 

  20. Wuillemin WA, Korte W, Waser G, Lämmle B. Usefulness of the D-dimer/fibrinogen ratio to predict deep venous thrombosis. J Thromb Haemost. 2005;3:385–7.

    Article  CAS  PubMed  Google Scholar 

  21. Liu J, Wang D, Xiong Y, Liu B, Lin J, Zhang S, et al. Association between coagulation function and cerebral microbleeds in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Aging Dis. 2017;8:131–5.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gornik HL, Sharma AM. Duplex ultrasound in the diagnosis of lower-extremity deep venous thrombosis. Circulation 2014;129:917–21.

    Article  PubMed  Google Scholar 

  23. Park SY, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann Intern Med. 2017;167:228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8:551–61.

    Article  CAS  PubMed  Google Scholar 

  25. Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-Dimer. J Am Coll Cardiol. 2017;70:2411–20.

    Article  CAS  PubMed  Google Scholar 

  26. Zhao TJ, Yang QK, Tan CY, Bi LD, Li J, Miao ZL. Prognostic value of D-dimer/fibrinogen ratio in the adverse outcomes of patients hospitalized for heart failure. Biomark Med. 2020;14:1733–45.

    Article  CAS  PubMed  Google Scholar 

  27. Xu DX, Du WT, Li X, Wu ZX, Yu GF. D-dimer/fibrinogen ratio for the prediction of progressive hemorrhagic injury after traumatic brain injury. Clin Chim Acta. 2020;507:143–8.

    Article  CAS  PubMed  Google Scholar 

  28. Chen X, Li S, Chen W, Xu F, Wang Y, Zou G, et al. The potential value of D-Dimer to fibrinogen ratio in diagnosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2020;29:104918.

    Article  PubMed  Google Scholar 

  29. Bai Y, Zheng YY, Tang JN, Yang XM, Guo QQ, Zhang JC, et al. D-Dimer to fibrinogen ratio as a novel prognostic marker in patients after undergoing percutaneous coronary intervention: a retrospective cohort study. Clin Appl Thromb Hemost. 2020;26:1076029620948586.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bai Y, Shi M, Yang X, Zhang W, Yang R, Wei X, et al. The value of FDP/FIB and D-dimer/FIB ratios in predicting high-risk APL-related thrombosis. Leuk Res. 2019;79:34–7.

    Article  CAS  PubMed  Google Scholar 

  31. Maung AA, Schuster KM, Kaplan LJ, Maerz LL, Davis KA. Risk of venous thromboembolism after spinal cord injury: not all levels are the same. J Trauma. 2011;71:1241–5.

    PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation (82102656); China Postdoctoral Science Foundation (2022T150452,2021M692299); PostDoctor Research Project, West China Hospital, Sichuan University (2021HXBH021); and Natural Science Foundation of Sichuan Province (2023NSFSC1580, 2022NSFSC1392, 2022NSFSC1312).

Author information

Authors and Affiliations

Authors

Contributions

CYW conceived and designed the study. CYW, XY, TTW, and LYR acquired the data, which CYW analyzed. CYW, XY, TTW, and MFD aided in data interpretation and wrote the manuscript. All authors were involved in revising the article and approved the final version.

Corresponding author

Correspondence to Changyi Wang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the Scientific Research Department of West China Hospital (approval no. 2021-1413).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, C., Yu, X., Wang, T. et al. D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury. Spinal Cord 61, 447–452 (2023). https://doi.org/10.1038/s41393-023-00905-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-023-00905-2

  • Springer Nature Limited

This article is cited by

Navigation