PREDICTIVE ACCURACY OF PLASMA D-DIMER LEVELS IN PREDICTING POOR NEUROLOGICAL OUTCOMES IN PATIENTS WITH ACUTE ISCHAEMIC STROKE: A PROSPECTIVE STUDY FROM A TERTIARY CARE HOSPITAL IN LAHORE, PAKISTAN

Abstract

Introduction: Acute ischaemic stroke (AIS) is a leading cause of death and disability worldwide. Timely neurological stratification is critical but often limited by delayed radiological access. Plasma D-dimer, a fibrin degradation product reflective of coagulation activity, has emerged as a promising, inexpensive biomarker for stroke severity prediction. Objective: To determine the predictive accuracy of plasma D-dimer levels in predicting poor neurological outcomes in AIS, using the National Institutes of Health Stroke Scale (NIHSS) as the gold standard. Study Design: Prospective cross-sectional study. Setting: Department of Medicine, Mayo Hospital (King Edward Medical University), Lahore, Pakistan. Duration: December 2, 2023 to June 2, 2024. Methods: Three hundred and twenty-one consecutive patients with first-episode AIS presenting within 24 hours were enrolled using non-probability consecutive sampling. Plasma D-dimer (threshold ≥310 ng/mL) was measured at admission. NIHSS was used to classify stroke severity. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were calculated. Stratified analyses were performed by age group and gender. Results: The mean age was 52.63 ± 12.89 years. Males comprised 54.21% (n=174). Mean NIHSS was 8.74 ± 8.34. Against NIHSS-defined severe outcome (n=16), D-dimer achieved: sensitivity 87.50%, specificity 96.39%, PPV 56.00%, NPV 99.32%, and accuracy 95.95%. Stratified analyses demonstrated consistently high specificity (≥93%) across all age groups and genders, with highest sensitivity in the 61–70 age group (100%) and in females (90.0%). Conclusion: Elevated plasma D-dimer (≥310 ng/mL) is a diagnostically accurate, low-cost biomarker for identifying poor neurological outcomes in AIS. Its exceptionally high NPV (99.32%) makes it a reliable rule-out tool in resource-limited settings