Higher Fibrinogen Research Articles

TP53 positivity combined with high fibrinogen expression defines a subtype of oral squamous cell carcinoma with an unfavorable prognosis

The number of deaths due to oral squamous cell carcinoma (OSCC), a malignant tumor of the oral cavity, is on the increase. We examined fibrinogen (FIB) expression in patients with OSCC and developed novel immunoprofile classification methods that include FIB. The plasma FIB level in patients with OSCC was elevated compared with that in patients with non-tumor oral disease (non-T); using a cut-off point of 342mg/dL, we found the area under the curve-receiver operating characteristic level for OSCC was 0.745. Similarly, FIB expression in OSCC tissues was significantly higher compared with that in non-T tissues. Hierarchical clustering based on the immunoprofile of several markers including FIB, p53, and p16 revealed four groups that could be used to categorize OSCC cases (referred to as immunoprofile subtypes[IPS], I-IV). Tumors in IPS-II, which were FIB+/p53+, were associated with a significantly worse overall survival (OS) when compared with the other subtypes. We conclude that our IPS classification system can facilitate prognostic evaluation in OSCC, and that quantification of FIB is an important component of the classification strategy for this disease.

Clinical Significance of Plasma D-Dimer and Fibrinogen in Outcomes after Stroke: A Systematic Review and Meta-Analysis

Background: There is increasing evidence on the prognostic significance of D-dimer and fibrinolysis in stroke. However, the systematic analysis of their relationship with adverse outcomes after stroke is lacking. Herein, we comprehensively assessed the correlation of D-dimer and fibrinolysis with stroke outcomes through meta-analysis. Methods: Studies for systematic literature review were retrieved from PubMed, EMBASE, and Cochrane Library databases. The association of D-dimer and fibrinolysis with outcomes of stroke patients was expressed as an odds ratio (OR) with 95% confidence intervals (95% CI). Results: Totally, 52 studies comprising 21,473 stroke patients were included. The results showed that the high D-dimer level was significantly associated with peripheral venous thrombosis after stroke (OR 1.03, 95% CI 1.01–1.05), poor outcome (MRS >2) after stroke (OR 1.731, 95% CI 1.464–2.048), death after stroke (OR 2.367, 95% CI 1.737–3.224), stroke recurrence (OR 1.229, 95% CI 1.113–1.358), and early neurologic deterioration (NIHSS >4) (OR 1.791, 95% CI 1.117–2.870). Moreover, high fibrinogen level was significantly associated with poor outcome (MRS >2) after stroke (OR 1.650, 95% CI 1.314–2.071), death after stroke (OR 1.310, 95% CI 1.128–1.520), stroke recurrence (OR 1.228, 95% CI 1.166–1.422), early neurologic deterioration (NIHSS >4) (OR 2.381, 95% CI 1.156–4.904), and coronary events after stroke (OR 1.427, 95% CI 1.232–1.653). Conclusion: Fibrinogen and D-dimer may be associated with adverse outcomes in patients with stroke, suggesting that they may serve as possible biomarkers for post-stroke adverse outcomes.

High fibrinogen to albumin ratio is associated with hematoma enlargement in spontaneous intracerebral hemorrhage

BackgroundWe investigate whether fibrinogen to albumin ratio could predict hematoma enlargement in patients suffered with spontaneous intracerebral hemorrhage. Materials and methodsA total of 149 patients met the entry criteria and received 1-month follow-up after discharge were divided into tertiles based on fibrinogen to albumin ratio levels (Tertile 1 [<8.06], Tertile 2 [8.06–10.33], Tertile 3 [>10.33]). Univariate analysis and binary logistic regression analysis was performed to explore the relationship between fibrinogen to albumin ratio and hematoma enlargement occurrence. ResultsThere was a significant difference in fibrinogen to albumin ratio between hematoma enlargement group and non-hematoma enlargement group (10.11 (8.37–11.73) vs 8.81 (7.61–10.39), p = .017). In binary logistic regression analysis, the highest tertile (>10.33) was independently related to hematoma enlargement (OR = 3.152, 95% CI = 1.326–7.493, p = .009). ConclusionFibrinogen to albumin ratio on admission might be an independent predictor of hematoma enlargement after intracerebral hemorrhage.

Preoperative fibrinogen level and postcardiac surgery morbidity and mortality rates.

High preoperative fibrinogen levels are associated with reduced bleeding rates after cardiac surgery. Fibrinogen is directly involved in inflammatory processes and is a cardiovascular risk factors. Whether high fibrinogen levels before cardiac surgery are a risk factor for mortality or morbidity remains unclear. This study aimed to examine the association between preoperative fibrinogen levels and mortality and morbidity rates after cardiac surgery. This is a single-center retrospective study. Patients (n = 1628) were divided into high (HFGr) and normal (NFGr) fibrinogen level groups, based on the cutoff value of 3.3 g/L, derived from the receiver operating characteristic (ROC) curve analysis. The primary outcome was the 30-day mortality rate. The rates of postoperative complications, including postoperative bleeding and transfusion rates, were examined. Between-group comparisons were performed with the Mann-Whitney U test and Chi-squared test, as suitable. Model discriminative power was examined with the area under the ROC curve. The HFGr and NFGr included 1103 and 525 patients, respectively. Mortality rate was higher in the HFGr than in the NFGr (2.7% vs. 1.1%, P = 0.04). The 12-h bleeding volume (280 mL [195-400] vs. 305 mL [225-435], P = 0.0003) and 24-h bleeding volume values (400 mL [300-550] vs. 450 mL [340-620], P &lt; 0.0001) were lower in the HFGr than in the NFGr. However, the rate of red blood cell transfusion during hospitalization was higher in the HFGr than in the NFGr (21.7% vs. 5.9%, P = 0.0103). Major complications were more frequent in the HFGr than in the NFGr. High fibrinogen levels were associated with reduced postoperative bleeding volume and increased mortality and morbidity rates.

The Prognostic Value of Preoperative Fibrinogen in Patients with Radical Cholecystectomy

Background and Aims. There is currently a lack of suitable hematological markers as a complement to pathological factors in predicting the prognosis of patients with gallbladder cancer. The study aimed to investigate the clinical value of preoperative fibrinogen levels in assessing the prognosis of patients with gallbladder cancer after radical surgery. Methods. The study retrospectively analyzed 260 gallbladder cancer patients who underwent radical resection. Time-dependent receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and fibrinogen. Besides, univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed to determine independent markers in peripheral blood. Then, subgroup analyses of fibrinogen in different degrees of differentiation, age, gender, and BMI were performed by log-rank test. Result. The cut-off values of fibrinogen, CEA, and CA19-9 were set at 2.97 g/L, 2.17 ng/mL, and 41.1 U/mL, respectively. The results showed that the preoperative fibrinogen level was associated with tumor size, degree of differentiation, TNM stage, and CA19-9 levels. Multivariate analyses indicated that advanced TNM stage, excessive fibrinogen, CEA, and CA19-9 levels were independent risk factors for postoperative DFS. And gallbladder neck tumors, poor differentiation, cancer nodules, advanced TNM stage, excessive fibrinogen, and CEA levels were independent adverse factors for postoperative OS. Notably, the preoperative excessive fibrinogen was an independent adverse factor for both DFS ( p = 0.044 , HR = 1.629 , 95% CI = 1.014 − 2.618 ) and OS ( p = 0.006 , HR = 2.328 , 95% CI = 1.272 − 4.261 ) in patients with gallbladder cancer. The subgroup analyses further indicated that patients with high-level of fibrinogen had both poorer DFS ( p = 0.002 ) and OS ( p = 0.005 ) than patients with poorly-differentiated gallbladder cancer. And for well-differentiated gallbladder cancer, patients with high fibrinogen levels had poorer OS ( p = 0.004 ), but no significant difference in DFS ( p = 0.062 ). Besides, fibrinogen was more significant in GBC patients with higher BMI (&gt;22.62) or older age (&gt;60 yrs) and was not affected by gender. Conclusion. Elevated preoperative fibrinogen level was independently associated with poor postoperative DFS and OS in patients with gallbladder cancer, especially for poor differentiation.

Lipoprotein a Combined with Fibrinogen as an Independent Predictor of Long-Term Prognosis in Patients with Acute Coronary Syndrome: A Multi-Center Retrospective Study.

Background: Patients with acute coronary syndrome (ACS) still have a high risk of recurrence of major adverse cardiovascular and cerebrovascular events (MACCE). However, there are rare studies on the prediction of MACCE in patients with ACS using lipoprotein a [Lp(a)] combined with fibrinogen. The aim of this study was to analyze the predictive value of Lp(a) combined with fibrinogen for the long-term prognosis of patients with ACS. Methods: 804 patients with ACS admitted to 11 tertiary general hospitals in Chengdu from January 2017 to June 2019 were included in the study. According to the Lp(a) 300 mg/L, patients were assigned to the non-high Lp(a) group and high Lp(a) group. Patients were assigned to the non-high or high fibrinogen groups using the fibrinogen level of 3.08 g/L. Subsequently, patients were divided into group A, B, or C by Lp(a) combined with fibrinogen. The study endpoints were MACCE, including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and revascularization. The incidences of MACCE among groups were compared. Lp(a), fibrinogen, Lp(a) combined with fibrinogen classifications were each added into the basic model to construct three new models. The C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) of the three new models were then compared. Results: The median follow-up was 16 months. During follow-up, the cumulative incidence of MACCE in group C was significantly higher than that measured in group A and B (p < 0.001). The results of the multivariate Cox regression analysis of MACCE showed that Lp(a) ≥300 mg/L with fibrinogen ≥3.08 g/L was an independent predictor of MACCE. According to the GRACE score and the statistical analyses, the basic model was constructed, which had a C-index of 0.694. The C-index, NRI, and IDI of the new model constructed using the basic model + Lp(a) combined with fibrinogen classification were 0.736, 0.095, and 0.094 respectively. Conclusions: Single Lp(a), single fibrinogen and Lp(a) combined with fibrinogen were independent predictors of MACCE in patients with ACS. The predictive value of Lp(a) combined with fibrinogen in patients with ACS was better than that of single Lp(a) and single fibrinogen.

Thrombin generation potential is increased in patients with autoimmune inflammatory myopathies

PurposeDermatomyositis and polymyositis (DM/PM) are rare autoimmune inflammatory myopathies, characterized by an increased risk of cardiovascular and thromboembolic events, likely related to the prothrombotic plasma properties. The aim of this study was to assess the in vitro thrombin generation profile as a biomarker of plasma procoagulant properties in DM/PM patients. MethodsIn 58 clinically stable DM/PM patients and 67 controls matched for sex, age, body mass index, we measured plasma thrombin generation potential using the Calibrated Automated Thrombinography (CAT) and analyzed its relationship with clinical disease characteristics, including autoantibodies profile. ResultsPatients with DM/PM had a 21% increase in endogenous thrombin potential (ETP), 36% higher peak thrombin concentration, and 11% faster thrombin generation, compared to controls (p ​< ​0.001, all, also after adjustment for potential confounders). Interestingly, although both diseases did not differ in thrombin generation potential, heterogenous variables predicted elevated ETPs in both of them. In DM, that was higher fibrinogen, C-reactive protein, and total cholesterol, whereas in PM, presence of arthritis and increased blood platelet count. Surprisingly, thrombin formation capacity remained in a robust inverse relationship with serum troponin (r ​= ​−0.67, p ​< ​0.001) in the patient group. ConclusionsDM/PM patients are characterized by an increased thrombin generation potential, suggesting prothrombotic plasma properties in both diseases. However, more studies are needed to verify its rationale and role in DM/PM clinical course and unfavorable clinical outcomes.

Role of predictable biomarkers in early detection of cardiovascular events in Chronic Kidney Disease III and IV

Abstract This comes about because of a lack of predicted biomarkers in the risk analysis of CVD events in chronic kidney disease (CKD) patients. The present study aimed to determine the clinical utility of independent, predictable biomarkers such as serum creatinine, estimated Glomerular Filtration Rate (eGFR), high sensitive C-Reactive protein (hsCRP), fibrinogen and lipid profile as early predictors of CVD in CKD at stage III/IV. Methods. This is a case-control study that includes a sample size of 100 patients of cases and 100 patients of controls who were recruited from November 2020 to April 2021, from the Nephrology department of the Visakhapatnam tertiary care teaching hospital, and present with chronic kidney disease – stage III/IV. The subjects’ general conditions (age, gender, height, weight, systolic blood pressure, diastolic blood pressure, and smoking history); underlying diseases (coronary heart disease and diabetes mellitus) were recorded. Fasting venous blood samples were collected under aseptic conditions from the study group after taking informed consent. The measurement of serum creatinine was performed by modification of kinetic Jaffe reaction. The Cockcroft-Gault equation was used to calculate eGFR in both cases and controls. CRP testing was done with a Cobas C311 analyzer, using immunoturbidimetric assay. The Fibroquant kit from Tulip was employed to measure fibrinogen levels in blood samples, and enzymatic methods were applied for lipid profile analysis. Results. In this study, higher mean values of hsCRP (34.28 mg/dl), increased serum creatinine levels (2.876 mg/dl), reduced eGFR (28.37 mls/min), high levels of serum fibrinogen (291.6 mg/dl), and cholesterol (214.5 mg/dl), HDL (28.34 mg/dl), TG (162.1 mg/dl), VLDL (32.41 mg/dl) and LDL (153.77 mg/dl) were found to be independent predictors of assessment of CV events in patients with CKD stages III and IV as determined by Chi-square test. Conclusion. A prompt and accurate assessment of cardiovascular risk in CKD patients would enable more aggressive and focused treatment of the individuals who are most in need of preventive interventions to decrease incident rates.

Elevated 8-isoprostane concentration is associated with thromboembolic events in patients with atrial fibrillation

BackgroundEnhanced oxidative stress occurs in atrial fibrillation (AF), however its impact on the efficacy and safety of anticoagulation is unknown. We sought to evaluate whether 8-isoprostaglandin F2 (8-isoprostane) levels are associated with clinical outcomes in anticoagulated AF patients. MethodsIn a study involving 243 AF patients (median age 69 years), we measured serum 8-isoprostane, along with prothrombotic markers, including plasma fibrin clot permeability, clot lysis time (CLT), endogenous thrombin potential (ETP), von Willebrand factor (VWF), and fibrinolytic proteins. Ischemic cerebrovascular events, major bleeding, and death were recorded during a median follow-up of 53 months while on anticoagulation, largely on non-vitamin K antagonist oral anticoagulants (NOACs). ResultsIncreased 8-isoprostane levels were observed in women, in patients with arterial hypertension, and those with paroxysmal or persistent AF. Patients with 8-isoprostane levels ≥559 pg/mL (the top quartile) compared with those with 8-isoprostane <250 pg/mL (the bottom quartile) had higher fibrinogen, lower VWF, higher plasminogen activator inhibitor 1, along with lower fibrin clot permeability with no difference in CHA2DS2-VASc score, CLT or ETP. Patients who experienced thromboembolic events (n = 20, 1.9%/year) had 48.6% higher 8-isoprostane concentrations compared to the remainder (P <0.01). Levels of 8-isoprostane >459 pg/mL based on the optimal cut-off value were associated with thromboembolic events during follow-up (hazard ratio 2.87, 95% confidence interval 1.17–7.03, P = 0.02). There were no associations between 8-isoprostane and major bleeding (2.0%/year) or all-cause mortality (1.9%/year). ConclusionsIncreased 8-isoprostane levels partly through altered fibrin clot structure are associated with thromboembolic events despite anticoagulant therapy in AF patients.

Effects of Dydrogesterone Tablets Combined with Zishen Yutai Pills on Threatened Abortion in Early Pregnancy and Pregnancy Outcomes.

Objective To explore the effect of dydrogesterone tablets combined with Zishen Yutai pills on threatened abortion in early pregnancy and pregnancy outcomes. Methods This study retrospectively analyzed the clinical data of 100 patients with threatened abortion in early pregnancy who came to the Linhai Second People's Hospital/Taizhou Municipal Hospital from January 13, 2021, to January 13, 2022. According to different treatment methods, 48 patients treated with progesterone injection were assigned to the control group (CG), while 52 cases with the combined therapy of dydrogesterone tablets and Zishen Yutai pills were assigned to the observation group (OG). The two groups were compared in terms of the following parameters: treatment efficacy, whole blood high shear viscosity, hematocrit (HCT), plasma fibrinogen (FIB) level, spiral artery pulsatility index (PI), uterine spiral artery blood flow resistance index (RI), lumbar and abdominal pain relief time, hemostasis time, estrogen levels, pregnancy outcomes, neonatal adverse outcomes, and incidence of adverse reactions. Results Compared with CG, the therapeutic effect in OG was observed to be evidently better, and its pain relief time and hemostasis time in the waist and abdomen were markedly shorter. After treatment, the whole blood high shear viscosity, FIB, RI, PI, and estrogen levels of both groups improved statistically compared with those before treatment, with more significant improvements in OG compared with CG. OG was also superior to CG with markedly lower incidence of preterm birth, miscarriage, neonatal adverse outcomes, and adverse reactions and a drastically higher full-term pregnancy rate. Conclusion Zishen Yutai pill combined with dydrogesterone tablets is of remarkable therapeutic effect in treatment of early threatened abortion, which can significantly improve clinical symptoms and pregnancy outcomes of patients, with a high safety profile, which is worthy of clinical application.

Serum Fibrinogen as a Biomarker for Disease Severity and Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis.

Background: Serum biomarkers associated with severe non-cystic fibrosis (CF) bronchiectasis are currently lacking. We assessed the association of serum fibrinogen, adiponectin, and angiopoietin-2 levels with the severity and exacerbation of bronchiectasis. Methods: Serum levels of fibrinogen, adiponectin, and angiopoietin-2 were measured and compared in patients with stable non-CF bronchiectasis (n = 61) and healthy controls (n = 16). The correlations between the three biomarkers and the bronchiectasis severity index (BSI) or FACED scores were assessed. Univariate and multivariate linear regression analyses were performed to identify variables independently associated with BSI and FACED scores in patients with bronchiectasis. Additionally, the exacerbation-free survival was compared between groups of patients with high and low fibrinogen levels, while the predictors of exacerbation were analyzed using Cox proportional hazards regression. Results: Patients with non-CF bronchiectasis carried higher fibrinogen (3.00 ± 2.31 vs. 1.52 ± 0.74 µg/mL; p = 0.016) and adiponectin (12.3 ± 5.07 vs. 9.17 ± 5.30 µg/mL; p = 0.031) levels compared with healthy controls. The serum level of angiopoietin-2 was comparable between the two groups (1.49 ± 0.96 vs. 1.21 ± 0.79 ng/mL, p = 0.277). Correlations of adiponectin and angiopoietin-2 with BSI and FACED scores were not significant. However, there were significant correlations between fibrinogen and both BSI (r = 0.428) and FACED scores (r = 0.484). Multivariate linear regression analysis revealed that fibrinogen level was an independent variable associated with both BSI and FACED scores. A total of 31 (50.8%) out of 61 patients experienced exacerbation during the follow-up period of 25.4 months. Exacerbation-free survival was significantly longer in patients with low fibrinogen levels than in those with high fibrinogen (log-rank test, p = 0.034). High fibrinogen levels and Pseudomonas colonization were independent risk factors for future exacerbation (HR 2.308; p = 0.03 and HR 2.555; p = 0.02, respectively). Conclusions: Serum fibrinogen, but not adiponectin or angiopoietin-2, is a potential biomarker closely associated with the severity and exacerbation of non-CF bronchiectasis.

Serum Fibrinogen Level and Cytokine Production as Prognostic Biomarkers for Idiopathic Sudden Sensorineural Hearing Loss.

No clinically useful prognostic factors have been identified for idiopathic sudden sensorineural hearing loss (ISSNHL). The current study therefore sought to identify useful prognostic factors for idiopathic sudden sensorineural hearing loss from blood biomarkers while attempting to classify the pathogenic mechanism and formulate treatment strategies based on these results. Prospective cohort study. Tertiary referral center. A total of 47 patients with acute phase ISSNHL were treated with steroid at an initial dose of 1 mg/kg/day and hyperbaric oxygen therapy and followed up for 6 months. Serum fibrinogen levels, peripheral blood mononu- clear cells (PBMCs), and interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α production levels from PBMCs were measured, after which patient's pre- and post- treatment hearing was compared. In the overall cohort, the mean improvement level, mean recovery rate, and mean fibrinogen level was 20.3 dB, 46.2%, 292.0 mg/mL, respectively. The mean levels of IL-1β, IL-6, and TNF-α produced by peripheral blood mononu- clear cells cultured under lipopolysaccharide stimulation were 318.4, 498.1, and 857.6 pg/mL, respectively. High fibrinogen levels were associated with poor hearing progno- sis. Lipopolysaccharide-stimulated cytokine production by PBMCs did not correlate with hearing changes; however, the prognosis was significantly better in patients with low fibrinogen levels and high IL-1β levels produced by PBMCs than in other patients. Our results suggest that patients with simple inflammatory-type ISSNHL responded well to standard therapy. Therefore, serum fibrinogen levels and PBMCs cytokine production may help determine the management of ISSNHL based on its pathogenic mechanism.

Coagulation parameters in lung cancer patients: A systematic review and meta-analysis.

BackgroundHypercoagulability in lung cancer patients is associated with a high incidence of mortality and morbidity in the world. Therefore, this meta‐analysis aimed to explore the correlation of the basic coagulation abnormalities in lung cancer patients compared with the control.MethodPubMed, Scopus, and other sources were employed to identify eligible studies. The outcome variable was expressed using mean ± standard deviation (SD). Heterogeneity among studies and publication bias were evaluated. The quality of included studies was also assessed based on Newcastle–Ottawa Scale checklist.ResultFinally, through a total of eight studies, prolonged prothrombin time (PT; standard mean difference [SMD]: 1.29; 95% CI: 0.47–2.11), plasma D‐dimer value (SMD 3.10; 95% CI 2.08–4.12), fibrinogen (SMD 2.18; 95% CI:1.30–3.06), and platelet (PLT) count (SMD 1.00; 95% CI 0.84–1.16) were significantly higher in lung cancer patients when compared with the control group. The single‐arm meta‐analysis also showed that compared with control, lung cancer patients had high pooled PT 13.7 (95% CI:12.2–15.58) versus 11.79 (95% CI = 10.56–13.02), high D‐dimer 275.99 (95% CI:172.9–11735.9) versus 0.2 (95% CI:0.20–0.37), high plasma fibrinogen 5.50 (95% CI:4.21–6.79) versus 2.5 (95% CI:2.04–2.91), and high PLT count 342.3 (95% CI:236.1–448.5) versus 206.6 (95% CI:176.4–236.7).ConclusionIn conclusion, almost all the coagulation abnormalities were closely associated with lung cancer, and hence coagulation indexes provide an urgent clue for early diagnosis and timely management.

Perioperative Risk Factors Associated with Unplanned Neurological Intensive Care Unit Events Following Elective Infratentorial Brain Tumor Resection

Our aim of this study was to identify risk factors and develop a prediction model for unplanned neurological intensive care unit (NICU) events after elective infratentorial brain tumor resection in order to propose an individualized admission to the NICU tailored to patient needs. Patients admitted to our NICU between September 2018 and May 2021 after elective infratentorial brain tumor resection were reviewed. Prolonged NICU stays and unplanned NICU admissions were defined as unplanned NICU events. The prognostic model of unplanned NICU events was developed using a forward stepwise logistic regression analysis, and external validation was evaluated. The C-statistic was used to assess discrimination, and a smooth, nonparametric calibration line was used to assess calibration graphically in the model. Of the 1,710 patients in the development cohort, unplanned NICU events occurred in 162 (9.5%). Based on the lesion type, a Karnofsky Performance Status score <70 at admission, longer duration of surgery, bleeding in the operative area evident on postoperative computed tomography, higher fibrinogen and blood glucose levels at admission, and more intraoperative blood loss were independently associated with unplanned NICU events. The external validation test showed good discrimination (C-statistic= 0.811) and calibration (Hosmer-Lemeshow P= 0.141) for unplanned NICU events. Several patient and operative characteristics are associated with a greater likelihood of the occurrence of unplanned NICU events. In the future, we may be able to provide better help for the resource allocation of NICUs according to these risk factors and prediction models.

Prognostic Impact of Using Combined Plasma Fibrinogen Level and Neutrophil-to-Lymphocyte Ratio in Resectable Non-small Cell Lung Cancer.

Both plasma fibrinogen level and neutrophil-to-lymphocyte ratio (NLR) are associated with malignant potential in different cancer types. The current study evaluated the use of combined plasma fibrinogen level and NLR (F-NLR) as a prognostic predictor in patients with non-small cell lung cancer (NSCLC). Data collected from 279 patients with resectable NSCLC were retrospectively reviewed. Patients were divided into three groups based on the F-NLR score: score 2, high fibrinogen level (≥350 mg/dL) and high NLR (≥2.5); score 1, either high fibrinogen level or high NLR; and score 0, neither abnormal. Overall survival (OS) and relapse-free survival (RFS) were evaluated using the Kaplan-Meier method and log-rank test. Cox proportional hazard model was used to assess prognostic factors. Numbers of patients with F-NLR score of 0, 1, and 2 were 122 (43.7%), 105 (37.6%), and 52 (18.6%), respectively. The F-NLR was found to be significantly associated with age, male sex, heavy smoking history, high pT status and pathological stage, and nonadenocarcinoma. Moreover, the OS and RFS significantly differed according to the F-NLR score (P < 0.001, P = 0.003). A multivariate analysis revealed that a high F-NLR score (≥1) was an independent poor prognostic factor for OS (P = 0.027). In subgroup analyses, an adverse prognostic impact of the F-NLR score on OS was identified regardless of nodal involvement or pathological stage. The F-NLR score, which is based on histological inflammation and coagulability, could be a potential prognostic indicator in patients with resectable NSCLC.

Hyperfibrinogenemia as a Poor Prognostic Indicator in Myelodysplastic Syndrome.

BackgroundMyelodysplastic syndrome (MDS) is a group of heterogeneous myeloid clonal diseases originating from hematopoietic stem cells. It has been demonstrated that fibrinogen (FIB) is associated with disease risk in several cancer types. Coagulation and fibrinolysis problems are widespread in MDS patients. Therefore, FIB might be one of these indicators. We thus examined the role of FIB levels in the prognosis of MDS.MethodsA cohort of 198 MDS patients were retrospectively analyzed to explore the prognostic value of the plasma FIB levels at diagnosis. Patients were divided into the high FIB group and low FIB group. The prognostic significance of FIB was determined by univariate and multivariate Cox hazard models.ResultsIn our cohort, the FIB levels in 198 MDS patients were higher than those in 100 healthy donors (3.9 g/L vs 2.9 g/L, P < 0.0001). MDS patients with high FIB levels had significantly shorter overall survival (OS; P = 0.001) and decreased leukemia-free survival (LFS; P = 0.036). Multivariate cox proportional hazards regression analysis indicated that, in addition to older age, gender, lower HB, poorer karyotype for OS, lower NE, and higher bone marrow blast percentage for OS and LFS, elevated FIB level was also an independent adverse prognostic factor for OS (P = 0.045) but not for LFS (P = 0.188).ConclusionElevated FIB levels may be associated with mortality risk among MDS patients and could predict disease progress and patient prognosis. Thus, assessment of FIB levels may promote the determination of the prognosis of MDS patients.

Features and Outcomes of Confirmed COVID-19 Patients Presenting to the Emergency Department

ObjectiveThis study is aimed to determine whether there is a correlation between demographic characteristics, symptoms, initial vital signs, laboratory findings, and clinical outcome(s) of patients with coronavirus disease 2019 (COVID-19).MethodsThis descriptive, single-center study retrospectively reviewed data from the medical records of patients confirmed with COVID-19 in a tertiary academic center in Jeddah, Saudi Arabia, between March and June 2020.ResultsThe present study enrolled 1039 patients (mean age ± SD, 45.16 ± 19.33 years) suffering from COVID-19, of whom 60.9% were not known to have any medical illnesses. The most common comorbidity was cardiovascular disease (27.8%). Patients with advanced age (p < 0.001), cardiovascular disease (p < 0.001), diabetes mellitus (p = 0.003), asthma (p = 0.008), renal disease (p = 0.020), fever (p = 0.002), dyspnea (p < 0.001), tachypnea (p < 0.001), low albumin (p < 0.001), low alkaline phosphatase levels (p = 0.008), high C-reactive protein (p = 0.003), high fibrinogen (p = 0.047), and high lactate levels (p = 0.015) were more likely to be admitted.ConclusionsPatients with increased age, multiple comorbidities, and unstable initial vital signs at emergency department presentation experienced a more severe course of COVID-19 and required admission.

Changes of blood D-dimer level after COVID-19 in patients with coronary heart disease

Funding AcknowledgementsType of funding sources: None.BackgroundCovid-19 was emerged in Wuhan and disseminated to the rest of the world. The virus may affect any kind of human organs. Aim of the study was to estimate the blood D-dimer level after Covid-19 in patients with coronary heart disease.Methods65 patients who were undergone Covid-19 (mild to moderate severity) without coronary heart disease (CHD; Group 1; aged 42-76 years, mean age 56.8±13.5 years) and 65 patients with CHD who was affected with Covid-19 (Group 2; aged 45-72 years, mean age 57.4±12.8 years) have been enrolled in this prospective study. Baseline characteristics were collected when first admitted to the hospital due to Covid-19, and follow-up characteristics were collected when they admitted to our hospital for the rehabilitation after undergoing Covid-19 in 3 months. Baseline and follow-up anthropometric, laboratory and instrumental data were assessed. All statistical analysis were performed by STATA software.ResultsMean blood D-dimer level significantly reduced in both groups (from 864 ng/mL to 475 ng/mL in the first group, P<0.05 vs. from 812 ng/mL to 452 ng/mL in the Group 2, P<0.05), however there were not observed statistically significant changes when compared to groups, P>0.05. In the first group mean D-dimer level tended to be higher in men, with high fibrinogen level, and older patients. In the second group, D-dimer level tended to be higher in patients with higher body mass index (BMI) with high fibrinogen level. In the first group in 31% of patients was observed high level of D-dimer (>500 ng/mL) after 3 months whereas in the second group elevated D-dimer level maintained in 28% of patients.ConclusionElevated blood D-dimer level are common after Covid-19, however concomitant CHD does not effect on it. Further studies are needed to reveal mechanisms of it.

Clinical, radiological and laboratory features and treatment responses of COVID-19 diseases in pregnant women

Background: SARS-CoV-2 is more contagious than other viruses among populations. Pregnant women&#x0D; are particularly susceptible to respiratory pathogens and severe pneumonia.&#x0D; Material and Methods: Thirty-two pregnant women who were diagnosed with COVID-19 disease by PCR test in our hospital between March 2020 and June 2020 were included in this study. Patients’ complaints, comorbid disorders, general physical conditions, radiological, laboratory characteristics, treatment results, and maternal and fetus health were recorded retrospectively.&#x0D; Results: The mean age of the patients was 26.6 years. Pregnancy-induced hypertension was evident in 2 patients (6.2%), preeclampsia in 1 patient (3.1%), asthma in 1 patient (3.1%). Mostly detected complaints were cough (34.4%) and fatigue (31.3%). The most frequent abnormal laboratory findings were high fibrinogen level (80.9%), high D-dimer level (71.4%), high CRP level (58.1%). Lymphopenia was found in 15.6% of patients. The maternal and fetal mortality rate was 0%. The rate of improvement in laboratory values in response to the treatment was as follows respectively; sodium (92.3%), lymphocyte count (80%), LDH (62.5%), CRP (61.1%), D-dimer (25%). None of the patients developed spontaneous abortion. Cesarean delivery was performed in 15.6% of patients. 5 newborns were negative for the COVID-19 PCR test two times.&#x0D; Conclusions: Mostly detected complaints in pregnancy patients with COVID-19 disease were cough and fatigue. While evaluating the treatment response, the improvement in sodium level may be more valuable than the improvement in acute phase reactants. The prognosis was quite good in mothers and children treated for this disease. The vertical transition of the disease could not be demonstrated.

Prognostic value of preoperative plasma fibrinogen levels in resected stage I non-small cell lung cancer.

BackgroundThe number of surgical procedures has increased among patients with early‐stage lung cancer. If the poor prognostic factors for stage I non‐small cell lung cancer (NSCLC) can be simply validated preoperatively, appropriate treatment will be provided. The current study aimed to evaluate the prognostic value of preoperative plasma fibrinogen levels in patients with resected stage I NSCLC.MethodsWe retrospectively analyzed the clinicopathological information of patients (n = 149) who underwent lobectomy for stage I NSCLC between May 2014 and July 2016. Data about peripheral blood analysis, histopathological finding, and follow‐up assessment results were collected from the databases. Patients were divided into the low and high fibrinogen groups. Univariate and multivariate analyses were performed to evaluate the predictors of recurrence and survival.ResultsCompared with the low fibrinogen group (<377 mg/dl), the high fibrinogen group (≥377 mg/dl) had a significantly greater number of male participants (p = 0.04), smokers (p < 0.001), and those with elevated cytokeratin antigen levels (p = 0.04), lymphatic invasion (p = 0.007), and squamous cell carcinoma (p < 0.001). Plasma fibrinogen level was considered a significant independent factor for recurrence and overall survival on both the univariate and multivariate analyses (p < 0.001 and p = 0.010) and the multivariate analysis alone (p = 0.020 and p < 0.012).ConclusionPreoperative plasma fibrinogen level might be a useful predictor of recurrence and survival in patients with stage I NSCLC. The treatment strategy for patients with high fibrinogen levels could be cautiously considered preoperatively.