Diagnostic performance of plasma D-dimer, fibrinogen, and D-dimer to fibrinogen ratio as potential biomarkers to predict hypertension-associated acute ischemic stroke
Endeshaw Chekol Abebe,
Tadesse Asmamaw Dejenie,
Denekew Tenaw Anley,
Misganaw Asmamaw Mengstie,
Natnael Atnafu Gebeyehu,
Getachew Asmare Adella,
Gizachew Ambaw Kassie,
Natnael Amare Tesfa,
Molalegn Mesele Gesese,
Sefineh Fenta Feleke,
Melkamu Aderajew Zemene,
Anteneh Mengist Dessie,
Wubet Alebachew Bayih,
Yenealem Solomon Kebede,
Berihun Bantie,
Mohammed Abdu Seid,
Engidaw Fentahun Enyew,
Gashaw Dessie,
Dagnew Getnet Adugna,
Teklie Mengie Ayele,
Assefa Agegnehu Teshome,
Fitalew Tadele Admasu
Affiliations
Endeshaw Chekol Abebe
Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia; Corresponding author. Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, P.O. Box:272; Postal code:6300, Debre Tabor, Ethiopia.
Tadesse Asmamaw Dejenie
Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Denekew Tenaw Anley
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
Misganaw Asmamaw Mengstie
Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
Natnael Atnafu Gebeyehu
Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
Getachew Asmare Adella
Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
Gizachew Ambaw Kassie
Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
Natnael Amare Tesfa
School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia
Molalegn Mesele Gesese
Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
Sefineh Fenta Feleke
Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
Melkamu Aderajew Zemene
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
Anteneh Mengist Dessie
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
Wubet Alebachew Bayih
Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
Yenealem Solomon Kebede
Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
Berihun Bantie
Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
Mohammed Abdu Seid
Department of Physiology, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
Engidaw Fentahun Enyew
Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Gashaw Dessie
Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Dagnew Getnet Adugna
Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Teklie Mengie Ayele
Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
Assefa Agegnehu Teshome
Department of Anatomy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
Fitalew Tadele Admasu
Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
Background: Ischemic stroke is a common type of stroke that leads to death and functional disability in hypertensive patients. However, there are no well-studied non-invasive and less expensive fluid biomarkers routinely used to detect ischemic stroke in hypertensive patients. Hence, this study aimed to tease out the performance of D-dimer, fibrinogen, and the D-dimer to fibrinogen ratio (DDFR) in predicting hypertension-associated acute ischemic stroke. Methods: A hospital-based cross-sectional study was done from October 2022 to January 2022 at Yikatit 12 Hospital Medical College, Ethiopia. We recruited 55 hypertensive patients who had an ischemic stroke and 110 who did not. A ROC curve was used to calculate the areas under the curves (AUCs) and determine the diagnostic power of the D-dimer, fibrinogen, and DDFR. The Youden index was used to find the best cut-off points for biomarkers in detecting acute ischemic stroke. A De Long test was employed to show whether there was a significant difference between the AUCs of biomarkers in diagnosing ischemic stroke. Results: D-dimer yielded the highest diagnostic power (AUC = 0.776) in detecting acute ischemic stroke, followed by DDFR (AUC = 0.763) and fibrinogen (AUC = 0.694), but there was no significant difference between them. At 0.52 μg/ml cut-off point, D-dimer had 82.9% sensitivity, 66.7% specificity, 62.5% PPV, and 85.3% NPV to diagnose acute ischemic stroke. Fibrinogen could detect acute ischemic stroke at 405.85 mg/dl level, with 70.0% sensitivity, 57.1% specificity, 41.2% PPV and 81.6% NPV. At a 1.83 ratio, DDFR might also identify ischemic stroke with 80.0% sensitivity, 67.1% specificity, 51.1% PPV, and 88.7% NPV. Conclusion: We showed D-dimer, fibrinogen, and DDFR as promising, affordable, and non-invasive biomarkers for the detection of ischemic stroke among subjects with hypertension. This will help clinicians make an early diagnosis and better guide patient therapy.
