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

doi:10.1016/j.heliyon.2024.e27192

Diagnostic performance of plasma D-dimer, fibrinogen, and D-dimer to fibrinogen ratio as potential biomarkers to predict hypertension-associated acute ischemic stroke

Heliyon. 2024 Feb 29;10(5):e27192. doi: 10.1016/j.heliyon.2024.e27192. eCollection 2024 Mar 15.

Authors

Endeshaw Chekol Abebe¹, Tadesse Asmamaw Dejenie², Denekew Tenaw Anley³, Misganaw Asmamaw Mengstie¹, Natnael Atnafu Gebeyehu⁴, Getachew Asmare Adella⁵, Gizachew Ambaw Kassie⁶, Natnael Amare Tesfa⁷, Molalegn Mesele Gesese⁴, Sefineh Fenta Feleke⁸, Melkamu Aderajew Zemene³, Anteneh Mengist Dessie³, Wubet Alebachew Bayih^{9

10}, Yenealem Solomon Kebede¹¹, Berihun Bantie¹², Mohammed Abdu Seid¹³, Engidaw Fentahun Enyew¹⁴, Gashaw Dessie², Dagnew Getnet Adugna¹⁴, Teklie Mengie Ayele¹⁵, Assefa Agegnehu Teshome¹⁶, Fitalew Tadele Admasu¹

Affiliations

¹ Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
² Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
³ Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
⁴ Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia.
⁵ Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia.
⁷ School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia.
⁸ Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia.
⁹ Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
¹⁰ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
¹¹ Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
¹² Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
¹³ Department of Physiology, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
¹⁴ Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
¹⁵ Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
¹⁶ Department of Anatomy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.

Abstract

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.

Keywords: Acute ischemic stroke; D-dimer; DDFR; Fibrinogen; Hypertension.