Dapeng Dai, Yong Sun, Hongwei Zhang, Aimin Li

Department of Neurosurgery, The First People’s Hospital of Lianyungang, Lianyungang City, Jiangsu Province, 222000, People’s Republic of China

Correspondence: Aimin Li, Department of Neurosurgery, The First People’s Hospital of Lianyungang, No. 182, Tongguan North Road, Haizhou District, Lianyungang City, Jiangsu Province, 222000, People’s Republic of China, Tel +86-0518-85605035, Email aiminli3561@163.com

Aim: Hemorrhagic stroke (HS) represents one of the major causes of death in China. The research work focuses on the correlation between Glasgow Coma Scale (GCS) score and D-dimer level, and the role of modified factors such as platelet count in HS patients.
Methods: This was a cross-sectional study that was conducted at the First People’s Hospital of Lianyungang, Lianyungang City, China. HS Patients were divided into three groups according to their GCS scores: GCS < 9 (severe, n = 43), 9 ≤ GCS < 13 (moderate, n = 97), and GCS ≥ 13 (mild, n = 487).
Results: The analysis comprised 627 participants. D-dimer levels were 142.0 ng/mL on average. The average GCS score was 13.6, and the average age was 61.0 years. The three GCS groups showed significant differences in D-dimer concentrations, diastolic blood pressure (DBP), and systolic blood pressure (SBP) (P < 0.001, P = 0.028, and P = 0.005, respectively). Among severe GCS scores (< 9), the D-dimer level was the highest at 237.0 ng/mL. After adjustment for possible confounders, the D-dimer concentrations were significantly lower in the moderate and mild GCS groups than in the severe group (P = 0.030 and P = 0.038, respectively). In the stratified analysis, the association between GCS categories and D-dimer levels was stronger among participants with low platelet counts (< 194 × 10^9/L; P for interaction = 0.017).
Conclusion: This study reveals a significant inverse association between D-dimer levels and GCS scores in HS patients, especially those with lower platelet counts. Elevated D-dimer levels may reflect coagulation and fibrinolysis activation, contributing to worse outcomes. Clinically, more attention and monitoring should be paid to the HS patients with elevated D-dimer levels.

Keywords: D-dimer, Glasgow coma scale, hemorrhagic stroke, platelet count, epidemiology, neurology