Heliyon (Mar 2024)

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

Journal volume & issue
Vol. 10, no. 5
p. e27192

Abstract

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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.

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