Arteriopathy, D-Dimer, and Risk of Poor Neurologic Outcome in Childhood-Onset Arterial Ischemic Stroke

作者：Goldenberg Neil A^*; Jenkins Sarah; Jack Jessica; Armstrong Wells Jennifer; Fenton Laura Z; Stence Nicholas V; Oleszek Joyce; Boada Richard; Wilkening Greta N; Wilkinson Charles; Soep Jennifer B; Miyamoto Shelley D; Bajaj Lalit; Mourani Peter M; Manco Johnson Marilyn J; Bernard Timothy J

来源：Journal of Pediatrics, 2013, 162(5): 1041-U211.

DOI：10.1016/j.jpeds.2012.11.035

Objective To assess whether acute findings of cerebral arteriopathy, large infarct, and acutely elevated plasma D-dimer levels are independently prognostic of poor long-term neurologic outcome as measured at %26gt;= 1 year post-event in children with arterial ischemic stroke (AIS). %26lt;br%26gt;Study design Sixty-one patients with childhood-onset (ie, %26gt;28 days of life) AIS were enrolled in a single-institution cohort study at Children%26apos;s Hospital Colorado between February 2006 and June 2011. Data on demographic and diagnostic characteristics, antithrombotic treatments, and outcomes were systematically collected. %26lt;br%26gt;Results Cerebral arteriopathy and D-dimer levels %26gt;500 ng/mL (a measure of coagulation activation) were identified acutely in 41% and 31% of the cohort, respectively. Anticoagulation was administered in the acute period post-event in 40% of the children, in the subacute period in 43%, and in the chronic period in 28%. When not receiving anticoagulation, patients were routinely treated with aspirin 2-5 mg/kg once daily for a minimum of 1 year. Death, major bleeding (including intracranial hemorrhage), and recurrent AIS were infrequent. The Pediatric Stroke Outcome Measure at 1 year demonstrated poor outcome in 54% of the children. Acute cerebral arteriopathy and elevated D-dimer level were identified as putative prognostic factors for poor outcome; after adjustment for D-dimer, arteriopathy was an independent prognostic indicator (OR, 19.0; 95% CI, 1.6-229.8; P=.02). %26lt;br%26gt;Conclusion Arteriopathy and coagulation activation are highly prevalent in the acute period of childhood AIS. Although recurrent AIS and intracranial hemorrhage were infrequent in our cohort, one-half of children experienced a poor neurologic outcome at 1 year, the risk of which was increased by acute arteriopathy. Substantiation of these findings in multi-institutional cohort studies is warranted, toward risk stratification in childhood-onset AIS. (J Pediatr 2013;162:1041-6).

• 出版日期2013-5