Higher Fibrinogen Research Articles

Effects of Lycii Fructus and Salviae Miltiorrhizae on the Syndrome of Deficiency with Blood Stasis in RCS (rdy-/-, p-/-) Rats with Retinitis Pigmentosa: An Intervention Study

ObjectiveTo investigate the effects of Lycii Fructus (LF, Gou Qi Zi, 枸杞子) and Salviae Miltiorrhizae Radix Ex Rhizoma (SM, Dan Shen, 丹 参 ) on the syndrome of deficiency with blood stasis in the RCS (rdy-/-, p-/-) rats with retinitis pigmentosa (RP). MethodsA total of 32 RCS (rdy-/-, p-/-) rats were divided into 4 groups (equal amounts of female and male rats in each group): model group treated with 0.9% normal saline, LF group treated with LF formula granules, SM group treated with SM formula granules, and LF and SM (L·S) group treated with LF and SM formula granules. Eight RCS (rdy +/ +, p +/ +) rats (4 males and 4 females) were treated with 0.9% normal saline to serve as blank group. The contents of E2, PG, P-Selectin, plasma viscosity, whole blood relative index of the high shear rate and fibrinogen content in plasma, and the content of cAMP and cGMP in retinal homogenate were detected. The retina was evaluated by hematoxylin-eosin staining. ResultsThe contents of E2, PG, P-Selectin, plasma viscosity, whole blood relative index of the high shear rate, and fibrinogen content in the plasma of L·S group significantly differed from those of model group (P < 0.01), but were similar to those of blank group. The contents of cAMP and cGMP in the retinal homogenate of L·S group significantly differed from those in model group (P < 0.01) but were similar to those in blank group (P > 0.05). ConclusionsLF and SM can effectively treat retinitis pigmentosa by ameliorating the syndrome of deficiency with blood stasis.

Lytic Susceptibility, Structure, and Mechanical Properties of Fibrin in Systemic Lupus Erythematosus.

Among complications of systemic lupus erythematosus (SLE), thrombotic events are relatively common and contribute significantly to the morbidity and mortality rates. An increased risk of thrombosis in various diseases has been shown to be associated with the lytic stability and mechanical stiffness of the fibrin clot determined by its structure. Here we studied alterations of the fibrin clot properties in relation to disease severity in SLE patients. Plasma clots from 28 SLE patients were characterized by the kinetics of formation and fibrinolytic dissolution (using dynamic turbidimetry), the network and fiber ultrastructure (scanning electron microscopy), viscoelasticity (shear rheometry), and the rate and degree of crosslinking (Western blotting) correlated with the disease activity, blood composition, and compared to clotting of pooled normal human plasma. Clots made from plasma of SLE patients were lysed faster with exogenous t-PA than control clots from normal plasma without a significant difference between those from active (SLEDAI>4) and inactive (SLEDAI<4) SLE patients. Clots from the blood of patients with active SLE were characterized by significantly slower onset, but faster rate of fibrin polymerization and a higher optical density due to thicker fibers compared to those from inactive SLE and control pooled normal plasma. The rheological parameters of the clots (storage and loss moduli) were significantly increased in the active SLE patients along with enhanced fibrin crosslinking and hyperfibrinogenemia. The structural and rheological alterations displayed a strong positive correlation with high fibrinogen levels and other laboratory markers of immune inflammation. In conclusion, changes in the blood composition associated with active systemic inflammation in SLE cause significant alterations in the lytic resistance of fibrin clots associated with changes in polymerization kinetics, viscoelastic properties, and structure. The formation of more rigid prothrombotic fibrin clots in the plasma of SLE patients is likely due to the inflammatory hyperfibrinogenemia and greater extent of crosslinking. However, the higher susceptibility of the SLE clots to fibrinolysis may be a protective and/or compensatory mechanism that reduces the risk of thrombotic complications and improves patient outcomes.

Fibrinolysis in patients with chemotherapy‐induced thrombocytopenia and the effect of platelet transfusion

Unlabelled Box BackgroundBleeding events in chemotherapy‐induced thrombocytopenic (CIT) patients with similar platelet counts might be influenced by changes in clot lysis potential. ObjectivesTo investigate, in an observational study, thromboelastographic lysis parameters, alterations in clot strength and susceptibility to clot lysis in CIT patients. To identify factors associated with fibrinolytic profiles, and to evaluate the effects of platelet transfusions. MethodsIndependent determinants of tissue‐type plasminogen activator (t‐PA)‐ROTEM lysis parameters were identified with multivariable linear regression. Clot formation, strength and lysis parameters were compared with the results of healthy individuals. Characteristics of CIT patients with and without hyperfibrinolytic profiles were compared. t‐PA‐ROTEM results before, 1 hour after and 24 hours after platelet transfusion were compared. ResultsA total of 72 consecutive CIT patients were included. t‐PA‐ROTEM lysis parameters correlated with changes in fibrinolytic proteins. Clot formation time was longer, maximum clot firmness was weaker and lysis times were shorter than in healthy individuals. CIT patients had low plasminogen activator inhibitor‐1 and thrombin‐activatable fibrinolysis inhibitor levels, and 40% showed hyperfibrinolytic profiles. Platelet transfusions resulted in less hyperfibrinolytic profiles in many, but not all CIT patients. Patients without hyperfibrinolytic profiles had higher fibrinogen, factor VIII and α2‐antiplasmin levels. Conclusionst‐PA‐ROTEM can be used as a fast and reliable assay to detect hyperfibrinolytic profiles in CIT patients. CIT patients have weaker clots, which are more susceptible to clot lysis, than healthy individuals. Besides platelets, other factors are likely to influence clot susceptibility to fibrinolysis in CIT patients. The impact of a hyperfibrinolytic t‐PA‐ROTEM profile on bleeding remains to be investigated.

Complete intestinal occlusion due to flanges andadhesions: case report

Background: Intestinal occlusion is the persistent arrest of intestinal transit, hinders movement towards distal sections. Adherence secondary to surgeries, the most frequent cause, collaborates in internal hernia formation in 4%. Need for surgical intervention is 6.4-10%. Case Report: Woman, 76 years old, 24 hours of evolution of generalized abdominal pain, due to crisis. Stopping 4-day and gas leak, 24 hours. Sigmoidostomy by CA of Sigmoid Colon. Physical examination: soft abdomen, depressant, diffuse pain, defense and pain in sudden decompression; RHA present. Increased soundness It presents neutrophilia, lymphopenia, thrombocytopenia. Urea, creatinine, BD, AST, TP, INR, high fibrinogen. Rx. of abdomen: hydroaryan levels. Ultrasound: Meteor. Simple TAC: obstruction of thin wings with multiple joints; in the transition zone. Diagnosis: Complete Intestinal Oclusion. Exploratory laparotomy consists of thin, violet coloration, multiple flanges and adhesions to the wall, epiplonic and interasas. They provide internal hernias with a 150-230 cm fitting of the fixed handle. Freezes and dissect adhesions and flanges with release of layered. Slim thin wings respond with better coloration and peristaltism. Discussion: 20% of cases of bowel occlusion caused by hernia, 1% of the total for internal hernia. Abdominal adhesions caused by 93% in postoperative cases, such as the picture. 95% of cases of flanges and adhesions are located in the small intestine, such as the presentation. Crisis type pain coincides as a symptomatology of the case. With compatible clinic, simple x-ray of abdomen and simple TAC (Gold Standard). Early surgery prevents intestinal strangulation, resulting in the restoration of the circulation and peristaltism of the wings.

Clinical and metabolic response to soy administration in older women with metabolic syndrome: a randomized controlled trial

BackgroundThere are many studies on the health effects of soy, only a few describe the effects of the simultaneous use of two types of soy on multiple components of metabolic syndrome (MetS). The present study was designed to determine the effects of roasted soy-nut and textured soy protein (TSP) intake on clinical and metabolic status of older women with MetS borderline parameters.MethodThis randomized, single-blind, controlled clinical trial included 75 women ≥ 60 years old with a diagnosis of MetS based on ATP III criteria. The participants were randomly allocated into three groups of 25 people; soy-nut, TSP and control groups for 12 week. Fasting blood samples were taken at the beginning and end of the trial to compare the metabolic responses. All participants provided three dietary records and physical activity records during the intervention. We used the Kolmogorov–Smirnov, ANOVA, ANCOVA, paired-t test, and the Generalized Linear Model (GLM) repeated measures analysis.ResultsDietary intake and physical activity of the participants in two groups were not significantly different. After 12 weeks of intervention the participants who received soy-nut had a significant decrease in total cholesterol (TC) (p < 0.001), low density lipoprotein, very low density lipoprotein, apolipoprotein B100, fasting blood glucose, insulin (p < 0.05), HOMA-IR, malondialdehyde (MDA) (p < 0.01) level. Morever, a significant increase in total antioxidant capacity (TAC) (p < 0.01) level compared with the control group. At the same time, the TSP brought significant decrease only in TC, insulin, MDA (p < 0.05) level and a significant increase in total TAC (p < 0.05) level. We did not find any significant effect in intervention groups, on apolipoprotein AI, triglyceride (TG), high density lipoprotein (HDL-C), TG/HDL, C-reactive protein and fibrinogen levels after intervention.ConclusionShort-term intakes of roasted soy-nut and TSP have shown to improve the lipid profiles, markers of glucose intolerance and oxidative stress; although the roasted soy-nut was more effective than TSP. Therefore, a moderate daily intake of roasted soy-nut as snacks or TSP as a meal complement by individuals with borderline parameters of MetS can be a safe and a practical modality to avoid the progression of the disease as well as to limit the side effects of drug intake.Trial registration MUBABOL.REC.1388.1

PS1588 FIBRINOLYSIS IN PATIENTS WITH CHEMOTHERAPY INDUCED THROMBOCYTOPENIA AND THE EFFECT OF PLATELET TRANSFUSION

Background:Bleeding events in chemotherapy induced thrombocytopenic (CIT) patients with similar platelet counts might be influenced by changes in clot lysis potential.Aims:In this observational study we investigated thromboelastographic lysis parameters, alterations in clot strength and susceptibility to clot lysis in CIT patients and identified factors associated with fibrinolytic profiles. Furthermore, the effects of platelet transfusions were evaluated.Methods:Independent determinants of tPA‐ROTEM lysis parameters were identified with multivariable linear regression. Clot formation, strength and lysis parameters were compared with results of healthy individuals. Characteristics of CIT patients with and without hyperfibrinolytic profiles were compared. tPA‐ROTEM results before, 1 hour and 24 hours after platelet transfusion were compared.Results:A total of 72 consecutive CIT patients were included. tPA‐ROTEM lysis parameters correlated with changes in fibrinolytic proteins. Compared to healthy individuals, clot formation time was longer, maximum clot firmness was weaker and lysis times were shorter. CIT patients had low PAI‐1 and TAFI levels and forty percent exhibited hyperfibrinolytic profiles. Platelet transfusions resulted in less hyperfibrinolytic profiles in many, but not all CIT patients. Patients without hyperfibrinolytic profiles had higher fibrinogen, FVIII and a2‐AP levels.Summary/Conclusion:tPA‐ROTEM can be used as a fast and reliable assay to detect hyperfibrinolytic profiles in CIT patients. CIT patients have weaker clots which are more susceptible to clot lysis compared to healthy individuals. Besides platelets, other factors are likely to influence clot susceptibility to fibrinolysis in CIT patients. The impact of a hyperfibrinolytic tPA‐ROTEM profile on bleeding remains to be investigated.

2463-PUB: Prevalence of Metabolic Syndrome in Patients with Type 1 Diabetes: Impact on Microvascular Complications and Subclinical Inflammation

Introduction: The MS might also be present in patients with DM1 worsening vascular prognosis. Objective: We aimed to determine the prevalence of MS and its association with microvascular disease and to describe the differences between patients with or without MS in markers of subclinical inflammation and adiposity. Methods: A cross-sectional study including 289 consecutive patients with DM1. MS was defined according to the criteria of the IDF but for the presence of fasting hyperglycemia or diabetes. Microvascular complications were assessed according to ADA. Serum inflammation markers such as high hsCRP, ESR, homocystein and fibrinogen were measured. Results: The mean age was 36 ± 12 years-old. 40% were female. Duration of DM1 was 20 ± 11 years. The mean HbA1c was 7.6±1.3% and the GFR was 94±18 ml/min/1.73m2. The prevalence of MS, as defined, was 12.5% (95% CI: 9.1 - 16.8). The odds of having microvascular complications was 2.4 higher among MS+ group [OR: 2.4 (1.0-5.7); P = 0.042] compared with MS- group, after adjusting for age and DM1 duration. Adiposity and markers of subclinical inflammation were significantly higher in MS+ group compared to their MS- counterparts (Table 1). Conclusions: The prevalence of MS was considerable in patients with DM1. MS was an independent risk factor for the presence of microvascular complications regardless of age and DM1 duration. The presence of MS in patients with DM1 is associated with adiposity and subclinical inflammation. Disclosure E. Lecumberri: None. M. Luque-Ramírez: None. J. Quiñones Silva: None. E. Fernández: None. S. Alonso Diaz: None. H. Escobar-Morreale: None. L. Nattero-Chávez: None. Funding Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness (PI1400649, PI151686, PIE1600050)

Clinical and prognostic significance of combined plasma fibrinogen concentrations and the monocyte-to-lymphocyte ratio in patients with ovarian cancer.

Fibrinogen concentrations and the monocyte-to-lymphocyte ratio (FC-MLR) are associated with progression and outcomes of many malignancies. This study aimed to assess the clinical and prognostic significance of the combination of plasma FC-MLR in patients with ovarian cancer. A total of 155 patients with epithelial ovarian cancer (EOC) and 102 patients with benign gynecological disease were retrospectively reviewed. The clinical and pathological data of all patients with EOC were analyzed. Plasma fibrinogen concentrations and the white blood cell (WBC) count were measured to calculate the MLR and neutrophil-to-lymphocyte ratio (NLR). Furthermore, the association of fibrinogen concentrations, the MLR, and FC-MLR with tumor stage, lymphatic and venous metastasis, and 5-year survival was assessed. Regression analysis was performed to evaluate the risk factors for progression of EOC. Receiver operating characteristic (ROC) curves were constructed to assess the prognostic power of plasma fibrinogen concentrations, the MLR, and FC-MLR, and to determine the optimal cutoff values of fibrinogen and the MLR. On the basis of the cutoff values, patients with EOC were divided into three groups: no abnormality, either increased, and both increased groups, respectively. The effect of FC-MLR on overall survival was calculated by the Kaplan-Meier method and compared by the log-rank test in the three groups. Patients with EOC had higher fibrinogen concentrations and a higher MLR than did controls (both P<0.01), and FC-MLR was closely associated with tumor stage and lymphatic and venous metastasis (all P<0.001). Furthermore, FC-MLR was an independent risk factor for progression of EOC (OR =8.985; 95% CI: 4.912-27.166; P<0.001), and patients with high fibrinogen concentrations and a high MLR showed a lower 5-year survival rate (P<0.001). FC-MLR may be used as a predictor of tumor progression and prognosis for ovarian cancer.

2218-PUB: Increased Platelet Reactivity Is Associated with Inflammation and Arterial Stiffness in Subjects with Prediabetes

We investigated markers of platelet reactivity and low-grade inflammation, and their association with early markers of vascular disease in subjects with prediabetes and new onset type 2 diabetes (NODM). Methods: 121 subjects without history of diabetes were stratified into 3 groups according to glycemic status: controls (n=41), prediabetes (n=42) and NODM (n=39). Platelet reactivity was evaluated as 11-dehydro thromboxane B2 urinary levels (TXB2), mean platelet volume (MPV) and platelet/lymphocytes ratio (PLR); cardiovascular risk was evaluated with arterial stiffness [pulse wave velocity (PWV), Augmentation pressure (AP), Subendocardial viability ratio (SEVR)] and intima media thickness (IMT). Results: Subjects with prediabetes exhibited: higher TXB2 urinary levels (10.7 ± 4.8 vs. 6.4 ± 1.8 pg/mg creatinine, p&amp;lt;0.05), PLR (143.7 ± 43 vs. 106.1 ± 26.7, p&amp;lt;0.05) and lower MPV (8.7 ± 0.7 vs. 9.5 ± 1.1 fl, p&amp;lt;0.05). Prediabetes showed higher fibrinogen and C creative protein (CRP) serum levels (333.2 ± 63 vs. 310.6 ± 58 mg/dL, p&amp;lt;0.05; 0.34 (0.11-0.47) vs. 0.14 (0.08-0.27) mg/dL, p&amp;lt;0.05, respectively). Subjects with prediabetes exhibited increased PWV, AP and IMT (8.1 ± 0.9 cm/sec vs. 7.5 ± 1.5, p&amp;lt;0.05; 13.2 ± 9.5 mmHg vs. 11.2 ± 4.6, p&amp;lt;0.05 and 710.2 ± 93.4 vs. 659 ± 93.1 μm, p&amp;lt;0.05, respectively) and decreased SEVR (159.4 ± 11 vs. 171.8 ± 32.3, p&amp;lt;0.05) compared with controls. No differences were found between prediabetes and NODM subjects regarding platelet reactivity and cardiovascular risk markers.TXB2 urinary levels were independently associated with hs-CRP, fibrinogen and HbA1c in multiple regression analysis. In simple regression analysis AP, PWV and SEVR showed a significant association with TXB2 urinary levels (r=0.32, p&amp;lt;0.05, r=0.16, p&amp;lt;0.05 and r=0.26 p&amp;lt;0.05 respectively). Conclusions: Subjects with prediabetes showed increased platelet reactivity and inflammation markers. These alterations were associated with early markers of cardiovascular disease. Disclosure A. Di Pino: None. F. Urbano: None. R. Scicali: None. S. Piro: None. A. Rabuazzo: None. F. Purrello: None. Funding University of Catania

Effects of Whole Body Vibration Training on Inflammatory Markers in Young Healthy Males

Background: The intensity of the vibration load refers to frequency and amplitude. Objectives: The present study aimed at reviewing the effects of high and low intensity whole body vibration training on inflammatory markers. Methods: Overall, 30 healthy male patients were divided to three groups, including control (N = 8), high intensity (N = 11), and low intensity (N = 11) groups. Training included consecutive weeks, three times each week with low intensity (amplitudes of 2 mm), high intensity (amplitudes of 4 mm), and progressive frequencies. Blood samples were analyzed for concentrations of high sensitivity C-reactive protein (hsCRP) and fibrinogen before and after completion of training. Paired sample t-test and One-way Analysis of Variance (ANOVA) were used to analyze the research findings (P ≤ 0.05). Results: Whole body vibration training with low and high intensities had no significant effects on hsCRP and fibrinogen levels (P ≥ 0.05). Conclusions: It appears that six weeks of low and high intensity vibration training has the same effects on CRP and fibrinogen.

Correlation of systemic and local inflammation with survival prognosis in glioma patients.

2052 Background: Immune modulating therapies have been a long withstanding treatment approach in glioma. However, gliomas are characterized by a particular absence of tumor infiltrating lymphocytes in the local tumor microenvironment. We aimed to gain insight on the distinct patterns of inflammation associated with survival prognosis in glioma. Methods: Patients were recruited at time of glioma diagnosis or progression in the prospective observational Vienna Cancer and Thrombosis Study (CATS). A single blood draw was performed at study inclusion. PD-L1 expression in the tumor tissue was investigated via immunohistochemistry. Optimal cut-off according to ROC curve was used to assess cut off values for survival analysis. Results: 193 patients with glioma (75.6% glioblastoma (WHO grade IV), 19.7% anaplastic glioma (WHO grade III), and 4.7% diffuse glioma (WHO grade II)) were included. 40/193 (20.7%) glioma had an IDH1 mutation. Membranous PDL1 expression in the tumor tissue was observed in 20/193 (10.4%) patients. 1/20 patient presented with PD-L1 expression and IDH1 mutation ( p = 0.082). PD-L1 significantly correlated with increased monocyte count (median: 0.657 vs. 0.450 [G/L], p = 0.008), higher C-reactive protein (CRP) (0.43 vs. 0.1 [mg/dL], p = 0.005) and higher fibrinogen (379 vs. 303 [mg/dL], p = 0.001). Presence of IDH1 mutation significantly correlated with increased platelet count (303 vs. 232 [G/L], p = 0.001) and lower Neutrophil/Lymphocyte (N/L) ratio (3.34 vs. 5.13, p = 0.016). Higher lymphocyte count ( &gt; 1.484 [G/L], log-rank: p = 0.011), higher platelet count ( &gt; 245.5 [G/L], p = 0.0001), as well as decreased N/L ratio ( &lt; 5.13, p = 0.001) were significantly associated with increased survival prognosis. Conclusions: PD-L1 expression in tumor tissue was associated with markers of systemic inflammation in glioma patients. Systemic inflammation markers furthermore predicted improved survival. Immune modulating therapy approaches might be a promising approach in subgroups of glioma associated with increased baseline interaction of immune system and glioma.

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.

Trousseau syndrome with multiple acute cerebral infarction as initial presentation: a clinical analysis of 12 cases

Clinical data of 12 cases of Trousseau syndrome with cerebral infarction as initial presentation admitted in the neurology department of the Fourth Affiliated Hospital of Hebei Medical University from December 2011 to December 2017 were retrospectively analyzed. Of the 12 patients, 4 cases had risk factors for cerebral infarction and 8 ones had no risk factors. There were 2 patients with 1 lesion and 10 patients with two or more lesions in brain imaging. The infarction lesions of 9 patients were located in 2 or more arterial blood supply areas. Ten patients showed an elevated plasma D-dimer level, 5 had elevated fibrinogen level, 7 showed increased blood platelet count and 8 had increased homocysteine level. Ten cases were confirmed by pathology, 2 cases by clinic and imaging diagnosis. The study suggests that multiple lesions with several cerebral arteries involved, high plasma D-dimer and fibrinogen levels may be the clinical characteristics of Trousseau syndrome with initial presentation as acute ischemic stroke and lacking of risk factors. The hypercoagulation state may be the important pathogenesis of this disorder. Key words: Neoplasms; Cerebral infarction; Signs and symptoms

The correlation between plasma fibrinogen level and different types of sudden sensorineural hearing loss

Objective: To investigate the correlation between plasma fibrinogen level and the incidence of sudden hearing loss. Method: A total of 225 patients (age ranging from 18 to 70 years) with sudden sensorineural hearing loss(SSNHL) were selected. The disease onset was within 2 weeks. No patient received previous medical intervention. Depending on the types of auditory threshold curve, SSNHL was divided into low frequency descending type, high frequency descending type, flat desending type and total deafness type. Two hundred and twenty-nine cases with normal hearing and no inflammatory diseases in the same period was selected as control group. Fibrinogen level and Blood Routine Indexes were detected for the purpose of retrospective cohort study.Result: The levels of fibrinogen in SSNHL group(2.98±0.59) g/L were significantly higher than that in control group(2.66±0.36) g/L (P<0.01). According to the types of auditory threshold curve, SSNHL groups were divided into group A(55 cases, 24.44%), Group B(36 cases, 16.00%), Group C(43 cases,19.11%) and Group D(91 cases, 40.44%). The average fibrinogen levels before treatment were at(2.75±0.46)g/L, (3.16±0.61) g/L, (3.02±0.63) g/L and(3.03±0.63) g/L respectively. There was no significant difference in fibrinogen level(P=0.286) between group A and the control group. Fibrinogen levels of group B, group C and group D were significantly elevated compared to control group (P<0.01). Conclusion: The level of fibrinogen is not significantly correlated with development of sudden deafness of low frequency descending type. The incidence of high frequency descending type, flat descending type and profound deafness type are all correlated with the level of high fibrinogen at the onset of sudden deafness. The classification of sudden deafness based on audiogram curves could be of great significance for analysis of possible causes and selection of treatment options.

Relationship between fibrinogen levels and cardiovascular events in patients receiving percutaneous coronary intervention: a large single-center study.

Background:It is currently unclear if fibrinogen is a risk factor for adverse events in patients receiving percutaneous coronary intervention (PCI) or merely serves as a marker of pre-existing comorbidities and other causal factors. We therefore investigated the association between fibrinogen levels and 2-year all-cause mortality, and compared the additional predictive value of adding fibrinogen to a basic model including traditional risk factors in patients receiving contemporary PCI.Methods:A total of 6293 patients undergoing PCI with measured baseline fibrinogen levels were enrolled from January to December 2013 in Fuwai Hospital. Patients were divided into three groups according to tertiles of baseline fibrinogen levels: low fibrinogen, <2.98 g/L; medium fibrinogen, 2.98 to 3.58 g/L; and high fibrinogen, ≥3.58 g/L. Independent predictors of 2-year clinical outcomes were determined by multivariate Cox proportional hazards regression modeling. The increased discriminative value of fibrinogen for predicting all-cause mortality was assessed using the C-statistic and integrated discrimination improvement (IDI).Results:The 2-year all-cause mortality rate was 1.2%. It was significantly higher in the high fibrinogen compared with the low and medium fibrinogen groups according to Kaplan-Meier analyses (1.7% vs. 0.9% and 1.7% vs. 1.0%, respectively; log-rank, P = 0.022). Fibrinogen was significantly associated with all-cause mortality according to multivariate Cox regression (hazard ratio 1.339, 95% confidence interval: 1.109–1.763, P = 0.005), together with traditional risk factors including age, sex, diabetes mellitus, left ventricular ejection fraction, creatinine clearance, and low-density lipoprotein cholesterol. The area under the curve for all-cause mortality in the basic model including traditional risk factors was 0.776, and this value increased to 0.787 when fibrinogen was added to the model (IDI = 0.003, Z = 0.140, P = 0.889).Conclusions:Fibrinogen is associated with 2-year all-cause mortality in patients receiving PCI, but provides no additional information over a model including traditional risk factors.

Association between glycemic control and serum fibrinogen levels in type 2 diabetes mellitus patients

Background: Poor glycemic control has been reported to be associated with increased vascular complications in diabetes mellitus (DM) patients. High fibrinogen level has been described as an independent risk factor for cardiovascular diseases. High fibrinogen has been suggested to be involved in the excess rate of cardiovascular diseases in patients with type 2 DM. The present study was undertaken to find correlation between glycemic control and plasma fibrinogen level in patients with type 2 DM.Methods: Three hundred ten patients aged ≥30 years of either sex were included in this cross sectional study. Estimation of glycated haemoglobin (HbA1c), serum fibrinogen, serum total cholesterol (TC), serum triglycerides (TG), serum high density lipoprotein (HDL) cholesterol, and serum low density lipoprotein (LDL) cholesterol was done. Categorical and continuous variables were tested using Chi-Square test/Fisher’s exact test and unpaired ‘t’ test respectively. Pearson’s correlation was used to study correlation between serum fibrinogen levels and HbA1c, Body mass index (BMI), TC, LDL cholesterol, HDL cholesterol, and TG.Results: Mean serum fibrinogen levels were significantly higher in DM patients whose HbA1c, LDL cholesterol and TG levels were higher. Correlation between serum fibrinogen was 0.59, and 0.45 with HbA1c, and BMI respectively. Multivariate step-wise regression analysis showed higher HbA1c and higher BMI were the independent and significant predictors of higher serum fibrinogen levels. HbA1c was the stronger predictor of serum fibrinogen than BMI.Conclusions: Fibrinogen levels were independently associated with HbA1c value in patients with type 2 DM.

The Correlation between Polymorphism of β Fibrinogen Gene -455 G/A and Serum Fibrinogen Level with The Severity of Coronary Artery Stenosis In Coronary Artery Disease Patient

Background: Now a days coronary artery disease (CAD) becomes major cause of death. One among 7 deaths in America caused by CAD. CAD is an atherosclerosis process, which progresively develops into plaque that will lead to stenosis of coronary artery lumen. Several studies found that high serum fibrinogen level is an independent and significant to the severity of artery coronary stenosis. Serum fibrinogen level determined by genetic factor. Polymorphism of fibrinogen gene β -455 G/A seem plays an important role in plasma fibrinogen level. Although some studies showed a significant correlation between polymorphism and cardiovascular diseases, but some other studies report inversely.&#x0D; Aim. To evaluate the correlation between the polymorphism of fibrinogen gene β -455 G/A and serum fibrinogen level with the severity of artery coronary stenosis.&#x0D; Method: This is an analytic correlative study with prospective approach without comparison. Coronary angiography was performed in catheterization labor in the department of internal medicine, while DNA analysis and PCR done in the department of microbiology in General Hospital dr Muhammad Husin Palembang- Indonesioa, since July 2015 until Agustus 2016. Samples are CAD patient who undergo for coronary angiography and fulfield the criterias. The severity of stenosis in coronary artery determined by Gensini score. This study included 31 patient.&#x0D; Results. Among 31 CAD patients, this study found severe stenosis of coronary artery in 17 patients (53,1%), moderate in 5 patients (15,6%) and mild in 10 patients (31,2%). Genetic analysis showed that serum fibrinogen level was controlled by polymorphism of fibrinogen gene β -455 G/A, concecutively by genotipe AA in 15 patients (48,4%), genotipe GA in 12 patient (38,7%) and by genotipe GG in 4 patients (12,9%). Chi Square test showed a significant correlation between polymorphism gene fibrinogen β -455 G/A and serum fibrinogen level (p=0,039). Spearman’s rho test found no significant correlation between serum fibrinogen level and severity of coronary artery stenosis based on Gensini score (r=0,142; p=0,447). And also this study found no significant correlation between polymorphism gene fibrinogen β -455 G/A with the severity of stenosis in coronary artery (p=0,512).&#x0D; Conclusion. Although this study succeded to prove that serum fibrinogen level was determined by polymorphism fibrinogen gene β -455 G/A, but there are no significant correlations between polymorphism fibrinogen gene β -455 G/A and serum fibrinogen level with severity of coronary artery stenosis in CAD patients. This study suggest to study other candidate gene to look for other cardiac risk beside this fibrinogen.&#x0D; Bangladesh Journal of Medical Science Vol.18(2) 2019 p.379-384

Abstract P106: Genetically Determined Fibrinogen, Gamma Prime Fibrinogen and Risk of Venous Thromboembolism and Ischemic Stroke: Evidence From Mendelian Randomization

Introduction: Fibrinogen is a key component of the coagulation cascade, and variation in its circulating levels may contribute to thrombotic diseases, such as venous thromboembolism (VTE) and ischemic stroke. Methods: Two-sample Mendelian randomization (MR) was applied to estimate the causal effect of circulating fibrinogen and its isoform, gamma prime fibrinogen, on risk of VTE and ischemic stroke subtypes using summary statistics from published genome-wide association studies of fibrinogen, VTE, and ischemic stroke, and an unpublished study of gamma prime fibrinogen. Genetic instruments for fibrinogen and gamma prime fibrinogen were selected by pruning genome-wide significant variants to linkage disequilibrium r 2 &lt; 0.1. The inverse variance weighted MR approach was used to estimate effects in the main analysis, with additional approaches that are more robust to the inclusion of pleiotropic variants applied in sensitivity analyses, including MR-Egger, weighted median MR, and weighted mode MR. Results: The main inverse variance weighted MR estimates ( Table ) based on 85 genetic instruments for fibrinogen and 27 genetic instruments for gamma prime fibrinogen indicated a protective effect of both fibrinogen and gamma prime fibrinogen levels on VTE risk. Higher fibrinogen levels decreased the risk of cardioembolic stroke but increased the risk of large artery and small vessel stroke. Higher gamma prime fibrinogen levels decreased the risk of all ischemic stroke, cardioembolic stroke, and large artery stroke. Effect estimates were consistent across sensitivity analyses, indicating that the results are unlikely to be attributable to the inclusion of pleiotropic variants. Conclusion: Our results are consistent with effects of genetically determined fibrinogen and gamma prime fibrinogen on VTE and ischemic stroke. The identified protective effects may reflect the diverse roles of the fibrinogen, beyond the formation of fibrin clots, in thrombotic diseases with different etiologies.

Hemophagocytic Lymphohistiocytosis and Infections: An Update.

Hemophagocytic Lymphohistiocytosis and Infections: An Update.

Impact of initial coagulation and fibrinolytic markers on mortality in patients with severe blunt trauma: a multicentre retrospective observational study

BackgroundAcute coagulopathy is a well-known predictor of poor outcomes in patients with severe trauma. However, using coagulation and fibrinolytic markers, how one can best predict mortality to find out potential candidates for treatment of coagulopathy remains unclear. This study aimed to determine preferential markers and their optimal cut-off values for mortality prediction.MethodsWe conducted a retrospective observational study of patients with severe blunt trauma (injury severity score ≥ 16) transferred directly from the scene to emergency departments at two trauma centres in Japan from January 2013 to December 2015. We investigated the impact and optimal cut-off values of initial coagulation (platelet counts, fibrinogen and prothrombin time-international normalised ratio) and a fibrinolytic marker (D-dimer) on 28-day mortality via classification and regression tree (CART) analysis. Multivariate logistic regression analysis confirmed the importance of these markers. Receiver operating characteristic curve analyses were used to examine the prediction accuracy for mortality.ResultsTotally 666 patients with severe blunt trauma were analysed. CART analysis revealed that the initial discriminator was fibrinogen (cut-off, 130 mg/dL) and the second discriminator was D-dimer (cut-off, 110 μg/mL in the lower fibrinogen subgroup; 118 μg/mL in the higher fibrinogen subgroup). The 28-day mortality was 90.0% (lower fibrinogen, higher D-dimer), 27.8% (lower fibrinogen, lower D-dimer), 27.7% (higher fibrinogen, higher D-dimer) and 3.4% (higher fibrinogen, lower D-dimer). Multivariate logistic regression demonstrated that fibrinogen levels < 130 mg/dL (adjusted odds ratio [aOR], 9.55; 95% confidence interval [CI], 4.50–22.60) and D-dimer ≥110 μg/mL (aOR, 5.89; 95% CI, 2.78–12.70) were independently associated with 28-day mortality after adjusting for probability of survival by the trauma and injury severity score (TRISS Ps). Compared with the TRISS Ps alone (0.900; 95% CI, 0.870–0.931), TRISS Ps with fibrinogen and D-dimer yielded a significantly higher area under the curve (0.942; 95% CI, 0.920–0.964; p < 0.001).ConclusionsFibrinogen and D-dimer were the principal markers for stratification of mortality in patients with severe blunt trauma. These markers could function as therapeutic targets because they were significant predictors of mortality, independent from severity of injury.