Elevated Plasma Fibrinogen Levels Research Articles

Evaluation of Plasma Fibrinogen Level, Platelet Count & Lipid Profile as Predictors of Cardiovascular Disease among Bangladeshi Healthy Male Smokers

Background: Smoking represents a substantial global health challenge, correlating with heightened rates of mortality and morbidity, notably including the onset of cancer. Within tobacco smoke are carcinogenic substances capable of perturbing cellular mechanisms and immune responses, thereby potentially influencing coagulation metrics and lipid profiles. Objective: This study aimed to investigate the plasma fibrinogen level, platelet count & lipid profile as predictors of cardiovascular disease among Bangladeshi healthy male smokers. Methods: A cross-sectional analytical study was conducted at the Department of Physiology, Sir Salimullah Medical College (SSMC) in Dhaka, Bangladesh, from July 1, 2018, to June 30, 2019. Seventy male participants aged 20 to 40 years were enrolled, comprising 35 healthy non-smokers (Group A) and 35 male smokers (Group B). Smokers were further categorized into two groups based on pack year (5-15 pack year for B1 & >15 pack year for B2). Coagulation parameters including plasma fibrinogen and platelet count and lipid profile were assessed. Results: The study comprised 70 subjects, evenly divided into Group A and Group B, with comparable mean ages of 33.17 ± 2.91 years and 34.11 ± 3.18 years, respectively, and similar mean body mass index (BMI) values of 24.36 ± 2.28 kg/m2 and 24.68 ± 2.33 kg/m2. Plasma fibrinogen levels were significantly higher in Group B (315.55 ± 67.79 mg/dL) compared to Group A (222.49 ± 23.03 mg/dL), as were platelet counts (285.14 ± 34.33 x109/L in Group B vs. 235.20 ± 46.83 x109/L in Group A). Further stratification of Group B revealed higher fibrinogen levels in both subgroups, B1 and B2, compared to Group A, with B2 exhibiting the highest fibrinogen levels. Platelet counts followed a similar trend, with both B1 and B2 having significantly higher counts than Group A. Plasma fibrinogen level was positively correlated with pack-years of smoking, while platelet counts showed a positive but statistically non-significant correlation. Smokers exhibited elevated total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) levels, along with decreased high-density lipoprotein (HDL) levels compared to non-smokers. Moreover, there was a significant positive correlation between pack-years of smoking and TC, TG, and LDL levels, while HDL levels exhibited a significant negative correlation. These findings underscore the complex interplay between smoking, coagulation parameters, and lipid profiles, emphasizing the multifaceted impact of smoking on cardiovascular health. Conclusion: In conclusion, the study highlights the intricate relationship between smoking, coagulation parameters, and lipid profiles in a cohort of 70 subjects. Smokers exhibited elevated plasma fibrinogen levels and platelet counts compared to non-smokers, with a significant positive correlation observed between pack-years of smoking and these coagulation parameters. Additionally, smokers demonstrated higher levels of total cholesterol, triglycerides, and low-density lipoprotein, alongside lower levels of high-density lipoprotein, indicative of dyslipidemic state in the direction of increased risk for coronary artery disease. Furthermore, the discovered alterations in plasma fibrinogen, platelet, and lipid profiles serve as early predictors of cardiovascular disease, advocating for proactive management strategies in individuals with a smoking history.

Fibrinogen and tumors.

Elevated plasma fibrinogen (Fg) levels consistently correlate with an unfavorable prognosis in various tumor patient cohorts. Within the tumor microenvironment, aberrant deposition and expression of Fg have been consistently observed, interacting with multiple cellular receptors and thereby accentuating its role as a regulator of inflammatory processes. Specifically, Fg serves to stimulate and recruit immune cells and pro-inflammatory cytokines, thereby contributing to the promotion of tumor progression. Additionally, Fg and its fragments exhibit dichotomous effects on tumor angiogenesis. Notably, Fg also facilitates tumor migration through both platelet-dependent and platelet-independent mechanisms. Recent studies have illuminated several tumor-related signaling pathways influenced by Fg. This review provides a comprehensive summary of the intricate involvement of Fg in tumor biology, elucidating its multifaceted role and the underlying mechanisms.

Fibrinogen and Atherosclerosis

Cardiovascular disease has a multifactorial origin. Among these risk markers, fibrinogen is the most prominent. Interest in the role of fibrinogen in the atherogenic process is long-standing. In the 1960s, one of the first studies correlating fibrinogen and coronary artery disease was published. Since then, much evidence has been accumulating establishing elevated plasma levels of fibrinogen as an independent risk factor for coronary artery disease. As in acute myocardial infarction, fibrinogen is also elevated in cases of cerebrovascular accident and peripheral artery disease. It is noteworthy that fibrinogen levels are elevated in patients with transient ischemic attacks, suggesting that fibrinogen levels should be elevated before necrosis occurs. It is known that plasma fibrinogen is a dimer made up of alpha, beta and gamma chains, whose union is made through disulfide bonds. Measures to reduce plasma fibrinogen include diet, alcohol, physical activity, and drugs. Since fibrinogen is a risk factor for coronary artery disease, measures to reduce its levels should be adopted. In the future, with the evolution of genetic studies, the detection of individuals predisposed to hyperfibrinogenemia may be performed. It is up to pharmaceutical research to continue the investigation of effective and easy-to-use drugs to reduce fibrinogen levels.

Amyloid pathology mediates the associations between plasma fibrinogen and cognition in non-demented adults.

Though previous studies revealed the potential associations of elevated levels of plasma fibrinogen with dementia, there is still limited understanding regarding the influence of Alzheimer's disease (AD) biomarkers on these associations. We sought to investigate the interrelationships among fibrinogen, cerebrospinal fluid (CSF) AD biomarkers, and cognition in non-demented adults. We included 1996 non-demented adults from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) study and 337 from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. The associations of fibrinogen with AD biomarkers and cognition were explored using multiple linear regression models. The mediation analyses with 10 000 bootstrapped iterations were conducted to explore the mediating effects of AD biomarkers on cognition. In addition, interaction analyses and subgroup analyses were conducted to assess the influence of covariates on the relationships between fibrinogen and AD biomarkers. Participants exhibiting low Aβ42 were designated as A+, while those demonstrating high phosphorylated tau (P-tau) and total tau (Tau) were labeled as T+ and N+, respectively. Individuals with normal measures of Aβ42 and P-tau were categorized as the A-T- group, and those with abnormal levels of both Aβ42 and P-tau were grouped under A+T+. Fibrinogen was higher in the A+ subgroup compared to that in the A- subgroup (p = 0.026). Fibrinogen was higher in the A+T+ subgroup compared to that in the A-T- subgroup (p = 0.011). Higher fibrinogen was associated with worse cognition and Aβ pathology (all p < 0.05). Additionally, the associations between fibrinogen and cognition were partially mediated by Aβ pathology (mediation proportion range 8%-28%). Interaction analyses and subgroup analyses showed that age and ApoE ε4 affect the relationships between fibrinogen and Aβ pathology. Fibrinogen was associated with both cognition and Aβ pathology. Aβ pathology may be a critical mediator for impacts of fibrinogen on cognition.

Plasma fibrinogen: a driver of left ventricular remodeling in patients undergoing peritoneal dialysis and its related risk factors

Background and aim Plasma fibrinogen has been proven to be significantly associated with cardiovascular mortality in patients undergoing peritoneal dialysis (PD). The study aimed to investigate the role of fibrinogen in left ventricular (LV) remodeling and functions in patients on PD, and explore risk factors related to high fibrinogen level. Methods From February 2008 to July 2018, adult patients on regular PD for at least 1 month were recruited and followed up for two years. Correlation analysis was performed to explore the fibrinogen level and echocardiography measurements. Pathogenic factors correlated to the left ventricular hypertrophy (LVH) progression were explored by logistic regression models and the role of fibrinogen in it was verified by receiver operating characteristic (ROC) curves. Linear regression models were conducted to identify factors associated with fibrinogen level. Results A total of 278 patients undergoing PD (168 males, 60.4%) were recruited. Patients were trisected according to fibrinogen levels at baseline. Mean wall thickness (MWT), relative wall thickness (RWT), and left ventricular mass index (LVMI) were positively associated with fibrinogen level while E/A ratio was negatively associated with it. Multivariate logistic regression and ROC curve showed that fibrinogen was an independent risk factor for LVH progression. Multivariate linear regression analysis identified age, total cholesterol (CHO), fasting blood glucose (FBG), and high-sensitivity C-reactive protein (hsCRP) were significantly related to plasma fibrinogen level. Conclusions An elevated fibrinogen level was independently associated with LVH progression in patients undergoing PD. Older age, higher level of FBG, CHO, and hsCRP were risk factors for elevated plasma fibrinogen level.

Venous Thromboembolism Following Major Abdominal Surgery for Cancer: A Guide for the Surgical Intern.

Venous thromboembolism (VTE) is a term used to compositely describe deep vein thrombosis (DVT) and pulmonary embolism (PE). Overall, the incidence of VTE after major abdominal and pelvic surgery has been reported to be between 10% and 40%. The aim of this study is to estimate the incidence of post-operative VTE in patients undergoing major abdominal surgery for cancer, to identify risk factors associated with VTE, and to assess available thromboprophylaxis tools. A Medline and Cochrane literature search from database inception until February 1st, 2021 was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Thirty-one studies met our eligibility criteria and were included in the current review. In total, 435,492 patients were identified and the overall incidence of VTE was 2.19% (95% CI: 1.82-2.38). Τhe following risk factors were associated with VTE: smoking, advanced age (>70 years), a history of diabetes mellitus, American Society of Anesthesiologists' (ASA) classification of Physical Health class III or IV, a history of cardiovascular or pulmonary disease, a history of DVT or PE, elevated plasma fibrinogen level, c-reactive protein (CRP) level, cancer stage III or IV, postoperative acute respiratory distress syndrome (ARDS), prolonged postoperative hospital stay, previous steroid use, history of Inflammatory Bowel Disease (IBD), heart failure and neoadjuvant and adjuvant chemotherapy. VTE remains an important complication after major abdominal surgery for cancer and seems to increase mortality rates.

Measurement of Plasma Fibrinogen Levels, PT and APTT among HIV Infected Patients: A Critical Bio-Marker for Coagulation Dysfunctions

Background: The literature stated that Human immunodeficiency virus (HIV) infection led to activation of coagulation, and habitually linked with an augmented risk of venous and arterial thrombosis. So the purpose of the study was to determine the plasma fibrinogen level in Sudanese HIV-infected patients.&#x0D; Materials and Methods: A total of one hundred participants were recruited, and classified into two groups; the case group include (50) HIV patients, and the control group enrolled (50) healthy individuals. Three ml of blood was collected. Fresh Poor Plasma was prepared from citrated venous blood by centrifuged for 15 minutes at 3000 pm. Fibrinogen levels were measured by an automated coagulation analyzer (Thrombolyzer XRC Germany). Data were collected using a directly structured questionnaire. Data were analyzed using SPSS Version 21. &#x0D; Results: The present study showed that the mean of plasma fibrinogen levels was statistically significantly higher in HIV infection in comparison with those normal healthy control (470.50 ±67.75 vs 214.75±21.25 with P-value 0.00). There was a significantly decreased level of PT, and PTT among the HIV group comparing with the control (9.575±0.64, and 22.39±4.94) VS (12.483±0.72, and 30.78±3.55) consequently, (P-value ≤0.001). Fibrinogen levels were significantly increased with the progression of HIV disease (469.84 ±67.15, 472.74 ±87.75, 478.47 ±61.92) in stage I, stage II, and stage III respectively.&#x0D; Conclusions: An HIV-infected patient had elevated plasma fibrinogen levels, as well as other coagulation dysfunctions.

Pathology and Mechanisms Underlying Thrombus Formation in Stroke

The mechanisms underlying atherothrombus and cardiac thrombus formation are complex and multifactorial. Ischemic stroke is characterized by large thrombus formation and vascular occlusion. The degree of plaque disruption and plaque thrombogenicity determine the size of the atherothrombus. Tissue factor-driven thrombin generation contributes to fibrin formation and platelet aggregation. As opposed to collagen, the von Willebrand factor (VWF) and fibrin may provide the scaffolds required for initial platelet adhesion on ruptured plaques. VWF also contributes to occlusive thrombus formation, following plaque disruption. Acute changes in shear stress and oscillatory shear stress can induce superficial erosive injury of plaques and thrombus formation. Atrial fibrillation causes atrial intimal thickening and thrombogenic factor expression, promotes stasis of blood in the left atrium and the left atrial appendage, and can contribute to thrombogenesis and elevated plasma VWF and fibrinogen levels. Coagulation Factor XI is a target for next-generation anticoagulants because it plays an important role in thrombus growth but not in hemostasis.

The preoperative elevated plasma fibrinogen level is associated with the prognosis of hilar cholangiocarcinoma.

Elevated fibrinogen (Fbg) levels contribute to tumor progression and metastasis. However, little is known regarding the association of the clinicopathological characteristics and the prognosis of hilar cholangiocarcinoma (HC) with plasma fibrinogen. Data on the plasma Fbg levels, clinicopathological characteristics, and overall survival were retrospectively collected. Plasma fibrinogen concentrations over 4.0g/L were classified as hyperfibrinogen, elevated fibrinogen, or abnormal fibrinogen levels. We then analyzed the relationships among plasma fibrinogen level, clinicopathological features, and patient prognosis. A total of 171 HC patients were included. An elevated plasma fibrinogen level was associated with lymph-node metastasis (P < 0.001), the AJCC stage (P < 0.001), the surgical margin (P = 0.005), and vascular invasion (P = 0.027). Univariate analyses revealed that preoperative plasma fibrinogen (P < 0.001), operative blood loss (P = 0.044), vascular invasion (P < 0.001), CA19-9 (P = 0.003), surgical margin (P < 0.001), T stage (P < 0.001), histologic differentiation (P = 0.007), and lymph-node metastasis (P < 0.001) were associated with OS. The survival time of patients with high Fbg levels was shorter than that of patients with normal fibrinogen levels (P < 0.001). Furthermore, a multivariate analysis showed that fibrinogen was negatively and independently associated with the HC prognosis (P = 0.029). An elevated plasma Fbg level was associated with lymph-node metastasis, vascular invasion, the surgical margin, and the tumor stage, and the Fbg level might therefore be an independent factor associated with poor outcomes in HC patients.

Elevated pretreatment plasma fibrinogen level is associated with metastasis of non-small cell lung cancer (NSCLC)

Abstract Objective The aim of this study was to investigate the correlation between pretreatment fibrinogen levels and metastasis in non-small cell lung cancer (NSCLC). Methods The study included 503 NSCLC patients with a clear pathological diagnosis and 168 patients diagnosed with benign lung diseases by histological examination. Pretreatment plasma fibrinogen values were quantified, and the relationship between plasma fibrinogen level and clinical variables comprising tumor size, metastasis, and clinical stage was examined using Kruskal-Wallis test, Wilcoxon rank sum test, and Chi-square test. Results The median plasma fibrinogen values were statistically higher in NSCLC patients with metastasis than patients with benign lung diseases and NSCLC patients without metastasis (Kruskal-Wallis test; P &lt; 0.001). Plasma fibrinogen values were also significantly higher in advanced clinical stages (Wilcoxon rank sum test; P &lt; 0.001). A significant relationship was observed between elevated fibrinogen (&gt; 2.974 g/L) and metastasis, clinical stage, and tumor size (Chi-square test; P &lt; 0.001). Conclusion This correlation suggests that elevated pretreatment plasma fibrinogen levels can predict metastasis and advanced tumor stage in NSCLC patients.

The Prognostic Value of Combination of Plasma Fibrinogen and CA19-9 in Non-Distant Metastatic Breast Cancer Patients Undergoing Surgery.

PurposeThis article aimed to study the prognostic value of preoperative plasma fibrinogen and CA19-9 in non-distant metastatic breast cancer (BC).Patients and MethodsA total of 343 non-distant metastatic BC patients were included in this study. The optimal cut-off values of plasma fibrinogen and CA19-9 were obtained by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to evaluate prognostic factors for overall survival (OS). Survival data were assessed using Kaplan–Meier survival analysis with the Log-rank test. Based on the cut-off values, we classified the fibrinogen-CA19-9 score as follows: 2 (both hyperfibrinogenemia and high CA19-9), 1 (either hyperfibrinogenemia or high CA19-9), and 0 (neither hypefibrinogenemia nor high CA19-9).ResultsOur follow-up time totaled 10 years, the median follow-up time was 77 months (range=2–119 months), and 82 (23.9%) of 343 patients died during the follow-up period. The optimal cut-off values of plasma fibrinogen and CA19-9 were 2.805 g/L and 11.85 U/mL, respectively. The multivariate Cox analysis results suggested that there was a significant association between worse OS and elevated preoperative plasma fibrinogen and CA19-9 levels (HR=2.016, 95% CI=1.216–3.342, P=0.007; and HR=2.042, 95% CI=1.282–3.253, P=0.003). The area under the ROC curve (AUC) increased from 0.589 (for plasma fibrinogen) and 0.594 (for CA19-9) to 0.640 when these two parameters were combined. When we added this combined factor to the multivariate analysis, it was an independent prognostic factor for BC (P<0.001). According to the above results, we chose four prognostic factors to construct our nomogram. The AUC was 0.724, which indicates that the nomogram performs well.ConclusionThe combination of plasma fibrinogen and CA19-9 could be used as a valid independent prognostic factor for non-distant metastatic BC compared with either parameter alone and could easily be applied in clinical practice.

Plasma fibrinogen and mortality in patients undergoing peritoneal dialysis: a prospective cohort study

BackgroundPlasma fibrinogen is significantly associated with cardiovascular (CV) events and mortality in the general population. However, the association between plasma fibrinogen and mortality in patients undergoing peritoneal dialysis (PD) is unclear.MethodsThis was a prospective cohort study. A total of 1603 incident PD patients from a single center in South China were followed for a median of 46.7 months. A Cox regression analysis was used to evaluate the independent association of plasma fibrinogen with CV and all-cause mortality. Models were adjusted for age, sex, smoking, a history of CV events, diabetes, body mass index, systolic blood pressure, hemoglobin, blood platelet count, serum potassium, serum albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, hypersensitive C-reactive protein, estimated glomerular filtration rate, antiplatelet agents and lipid-lowering drugs.ResultsThe mean age was 47.4 ± 15.3 years, 955 (59.6%) patients were male, 319 (19.9%) had a history of CV events, and 410 (25.6%) had diabetes. The average plasma fibrinogen level was 4.12 ± 1.38 g/L. Of the 474 (29.6%) patients who died during follow-up, 235 (49.6%) died due to CV events. In multivariable models, the adjusted hazard ratios (HRs) for quartile 1, quartile 3, and quartile 4 versus quartile 2 were 1.18 (95% confidence interval [CI], 0.72–1.95, P = 0.51), 1.47 (95% CI, 0.93–2.33, P = 0.10), and 1.78 (95% CI, 1.15–2.77, P = 0.01) for CV mortality and 1.20 (95% CI, 0.86–1.68, P = 0.28), 1.29 (95% CI, 0.93–1.78, P = 0.13), and 1.53 (95% CI, 1.12–2.09, P = 0.007) for all-cause mortality, respectively. A nonlinear relationship between plasma fibrinogen and CV and all-cause mortality was observed.ConclusionsAn elevated plasma fibrinogen level was significantly associated with an increased risk of CV and all-cause mortality in patients undergoing PD.

Emerging evidence of a COVID-19 thrombotic syndrome has treatment implications.

Reports of widespread thromboses and disseminated intravascular coagulation (DIC) in patients with coronavirus disease 19 (COVID-19) have been rapidly increasing in number. Key features of this disorder include a lack of bleeding risk, only mildly low platelet counts, elevated plasma fibrinogen levels, and detection of both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and complement components in regions of thrombotic microangiopathy (TMA). This disorder is not typical DIC. Rather, it might be more similar to complement-mediated TMA syndromes, which are well known to rheumatologists who care for patients with severe systemic lupus erythematosus or catastrophic antiphospholipid syndrome. This perspective has critical implications for treatment. Anticoagulation and antiviral agents are standard treatments for DIC but are gravely insufficient for any of the TMA disorders that involve disorders of complement. Mediators of TMA syndromes overlap with those released in cytokine storm, suggesting close connections between ineffective immune responses to SARS-CoV-2, severe pneumonia and life-threatening microangiopathy.

Elevated plasma fibrinogen indicates short-term poor outcome in patients with acute ischemic stroke after intravenous thrombolysis

Fibrinogen is a central protein of hemostasis and a major determinant of plasma viscosity and key factor for platelet activation. The aim of this study is to investigate the relationship between fibrinogen level and short-term outcome in acute ischemic stroke patients receiving intravenous thrombolysis. This retrospective study included 176 acute ischemic stroke patients who received intravenous thrombolysis with recombinant tissue plasminogen activator and provided plasma fibrinogen level within 24h after stroke onset. Patients were categorized by plasma fibrinogen level: Quartile 1 (≤ 1.74g/L), Quartile 2 (1.75-2.08g/L), Quartile 3 (2.09-2.69g/L), and Quartile 4 (> 2.69g/L). The medical record of each patient was reviewed, and demographic, clinical and laboratory information was abstracted. Functional outcome at 14 days was assessed with the modified Rankin Scale. Poor outcome was present in 75 (42.6%) of the 176 patients that were included in the study (mean age, 72 years; male, 53.4%). After adjustment for potential confounding variables, higher plasma fibrinogen level on admission was associated with poor outcome (adjusted odds ratio 10.45, 95% confidence interval 1.49-73.15 for Q4:Q1; P = 0.02). According to receiver operating characteristic analysis, the best discriminating factor for poor outcome was a plasma fibrinogen level ≥ 2.585g/L (area under the curve 0.672; sensitivity 50.7%; specificity 86.1%). Elevated plasma fibrinogen levels on admission are significantly associated with poor outcome after admission for acute ischemic stroke, suggesting the potential role of plasma fibrinogen level as a predictive marker for short-term poor outcome in acute ischemic stroke patients receiving thrombolytic therapy.

Correlation of fibrinogen level with lipid profile in type 2 diabetes mellitus

Background: Increasing evidence from epidemiological studies suggest that elevated plasma fibrinogen levels are associated with an increased risk of cardiovascular disorders especially in diabetic patients. Objective was to correlate fibrinogen levels in patients of type-2 diabetes mellitus with lipid profile.Methods: It is a descriptive observational study conducted among type-2 diabetes mellitus patients at Khaja Bandanawaz Institute of Medical Sciences, Gulbarga in year 2011. Newly detected type-2 diabetic patients with and without associated hypertension of more than 40 years of age belonging to both sexes were included.Results: Total 104 patients were involved in our study. Of which 75 were males and 29 females. There was a significant positive correlation between plasma cholesterol level and plasma fibrinogen level. The patients who had serum triglyceride level between 100-149 mg/dL had plasma fibrinogen level about 4.19±0.1 g/L and those with serum triglyceride level more than 400 mg/dL &lt; had 9.01±0.83 g/L plasma fibrinogen level. Significant positive correlation between serum triglyceride level and plasma fibrinogen level found. 36 patients with HDL level 35-39 mg/dL had plasma fibrinogen level of 5.9±1.50 g/L. So, there was a significant negative correlation between serum HDL and plasma fibrinogen level.Conclusions: The present study showed positive correlation between serum cholesterol level, LDL level and triglyceride level with plasma fibrinogen levels. There was inverse relation with HDL level.

The risk of elevated plasma fibrinogen level in hypertensive and normotensive patientsafter bevacizumabintravitreal injection in diabetic retinopathy

Bevacizumab intravitreal injection (IVB) could be detected in plasma that might cause an imbalance in the coagulation system. A hypercoagulable state is potentially involved in the risk for thrombosis, which is associated with high cardiovascular mortality.The objective of the current study was to investigate the risk of elevated plasma fibrinogen levelsin hypertensive and normotensive patients after IVB in diabetic retinopathy. This study was conducted at Dr. Sardjito General Hospital, Yogyakarta from March to June 2019. A total of 64 patients were enrolled in the study, included of 32 hypertensive and 32 non-hypertensive patients with diabetic retinopathy who underwent IVB. Patients were interviewed and investigated for physical condition and opthalmological examination. Fibrinogen levelwas measured before and 1 week after IVB. The mean fibrinogen level beforeand after IVB was slightly high in hypertensive patients than normotensive but not significantly different(p>0.05). There was no significant risk of increased fibrinogen levels after IVB in the hypertension group compared to the normotension group in diabetic retinopathy patients. The proportion of patients at high risk for cardiovascular disease after IVB was not significantly different between both groups.

Preoperative elevated plasma fibrinogen level predicts tumor recurrence and poor prognosis in patients with hepatocellular carcinoma.

Elevated plasma fibrinogen has been reported to be associated with poor prognosis in several cancers. The aim of present study was to investigate the prognostic value of preoperative plasma fibrinogen in hepatocellular carcinoma (HCC) patients. Data were collected retrospectively from 302 HCC patients who received hepatectomy. The association between fibrinogen and clinicopathological characteristics was evaluated. Both univariate and multivariate analyses were performed to identify prognostic factors for disease-free survival (DFS) and overall survival (OS). And accordingly, the nomograms were constructed. Elevated plasma fibrinogen (>4 g/L) was correlated with larger tumor diameter, the presence of vascular invasion, lower MELD score, higher NLR, advanced Barcelona Clinic Liver Cancer stage and poor-moderate pathological differentiation. On multivariate analysis, the elevated plasma fibrinogen was found independently associated with poor DFS (HR =1.575, P=0.024) and OS (HR =2.051, P=0.025). And the nomograms including fibrinogen were constructed to predict DFS and OS for HCC patients. Both DFS and OS in patients with plasma fibrinogen >4 g/L were significantly lower than those with fibrinogen ≤4 g/L (1-, 3-, 5-year DFS: 34.2%, 19.5% and 0.0% vs. 60.4%, 34.2% and 30.2%; 1-, 3-, 5-year OS: 83.4%, 62.7% and 48.8% vs. 95.4%, 84.3% and 75.8%, both P<0.001). Besides, subgroup analyses also showed the prognostic values of fibrinogen in HCC patients with/without cirrhosis or high AFP levels, and in those with single tumor and BCLC 0-A stage. Preoperative elevated plasma fibrinogen was an independent prognostic factor associated with poor prognosis in HCC patients receiving liver resection.

High levels of plasma fibrinogen are related to post-stroke cognitive impairment.

IntroductionStudies have shown that high levels of the fibrinogen (FIB) are related to cognitive deficits. However, the relationship between fibrinogen and cognitive deficit after stroke remains unclear. Therefore, we explored the relationship between plasma fibrinogen and post‐stroke cognitive impairment (PSCI).MethodsThis study is carried out in the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. A total of 210 patients with acute ischemic stroke were enrolled in this study. Ultimately, 134 patients completed 3‐month follow‐up. Blood samples were collected at hospital admission. Cognitive function was evaluated 3 months after stroke. All patients underwent the Mini‐Mental State Examination (MMSE) after 3 months.ResultsHigher levels of fibrinogen were observed in patients with post‐stroke cognitive impairment compared with the non‐PSCI group (p < .001). Additionally, elevated plasma fibrinogen levels were independently associated with PSCI (odds ratio [OR] = 2.000, 95% CI 1.062–3.770 p = .032). The plasma fibrinogen levels were negatively correlated with the 3‐month MMSE scores (r = −.171, p = .048). In a multivariate linear regression, FIB was negatively associated with the 3‐month MMSE scores after adjustment for the other variables (β = −0.782, p = .035).ConclusionHigh levels of plasma fibrinogen were associated with the presence and severity of PSCI.

Systemic immune-inflammation index, serum albumin, and fibrinogen impact prognosis in castration-resistant prostate cancer patients treated with first-line docetaxel.

To evaluate the prognostic value of pretreatment plasma systemic immune-inflammation index (SII), albumin, and fibrinogen levels in metastatic castration-resistant prostate cancer (mCRPC) patients treated with first-line docetaxel and to screen out the patients with the greatest risk for poor prognosis. The plasma SII, albumin, and fibrinogen levels were examined before treatment and analyzed with patient clinicopathological parameters and overall survival (OS). The survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed using the Cox proportional hazard regression model. The incidences of elevated SII level, hypoproteinemia, and hyperfibrinogenemia were 52.51%, 25.14%, and 27.93%, respectively. SII level was associated with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) (P < 0.001). Albumin level was found closely correlated with ECOG PS (P = 0.006), PLR (P = 0.042), and hemoglobin (P = 0.009), but not other parameters. Elevated plasma fibrinogen level was significantly associated with Eastern Cooperative Oncology Group performance status (ECOG PS) (P = 0.009), visceral metastases (P < 0.001), and PLR (P = 0.001). In multivariate Cox regression model, visceral metastases SII (HR 2.133, 95% CI 1.163-3.913; P = 0.014), albumin (HR 0.540, 95% CI 0.307-0.949; P = 0.032), and fibrinogen (HR 1.888, 95% CI 1.069-3.335; P = 0.029) were further confirmed to be the independent prognostic factors for OS. Of the three target parameters, we found that patients with none abnormalities of the three parameters showed the best prognosis, and patients with at least any two abnormalities of them showed markedly worse prognosis than patients with any one abnormalities of the three parameters (P < 0.001). Pretreatment SII, albumin, and fibrinogen are independent prognostic factors in mCRPC patients treated with first-line docetaxel. Moreover, the combined use of SII, albumin, and fibrinogen levels may help us to identify the high-risk populations for treatment decisions.

Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy.

BackgroundEarly identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients.MethodsA total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected.ResultsMedian follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC.ConclusionAge and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.