Activation of the coagulation and fibrinolysis system is a significant factor in secondary brain injury following spontaneous intracerebral haemorrhage (ICH). However, the relationships between plasma D-dimer, the smallest fibrinolysis-specific degradation product, and its implications for haematoma expansion (HE), in-hospital mortality, and coma at discharge in ICH patients have yet to be system-atically explored, highlighting the need for further research in this area.

In this study, we conducted a comprehensive assessment of plasma D-dimer levels in a sample consisting of 451 patients diagnosed with ICH and 114 healthy controls. Our approach included baseline measurements, such as haematoma volume, National Institutes of Health Stroke Scale (NIHSS) scores, and Glasgow Coma Scale (GCS) scores, to evaluate and quantify neurological deficits following ICH. Logistic regression analysis was used to determine the independent relationship between plasma D-dimer levels and clinical outcomes. To investigate the role of D-dimer in secondary brain injury, we analysed the changes in plasma D-dimer levels at admission and on days 3, 7, and 14 in the ICH with HE subgroup. Finally, we conducted a prognostic evaluation based on in-hospital mortality and the rate of coma at discharge.

The study revealed a marked increase in plasma D-dimer levels among patients with ICH compared with healthy controls (489.4 ± 1026 vs. 99.34 ± 55.09, p < 0.0001). This increase in plasma D-dimer levels strongly correlated with the severity of haemorrhage. Additionally, logistic regression analysis indicated that elevated plasma D-dimer levels were associated with poor clinical outcomes following ICH. Notably, plasma D-dimer levels within the HE subgroup significantly increased during the acute phase of ICH. Furthermore, both in-hospital mortality and the incidence of coma at discharge progressively increased with increasing D-dimer levels.

Elevated plasma D-dimer levels in patients with ICH significantly correlate with in-hospital mortality and the rate of coma at discharge. Notably, these levels markedly increase during the acute phase of the ICH with HE subgroup. These significant findings underscore the pivotal role of D-dimer as a biomarker in secondary brain injury following ICH and offer a novel predictive indicator for clinical outcomes associated with this condition.