High Plasma Fibrinogen Levels Research Articles

Plasma Fibrinogen Predicts the Prognosis of Bladder Cancer Patients After Radical Cystectomy.

BackgroundThis study aimed to determine the potential utility of plasma fibrinogen as a prognostic factor in patients with bladder cancer (BCa) after radical cystectomy (RC).MethodsPatients with BCa who underwent RC from 2014 to 2019 were analyzed retrospectively. The indexes of plasma coagulation and fibrinolysis system factors were collected. Kaplan–Meier survival curves were used to calculate the overall survival (OS) and disease-free survival (DFS). The prognostic value of plasma fibrinogen was analyzed by using Cox regression model, and a nomogram of BCa based on plasma fibrinogen was generated by R software.ResultsAmong 145 patients, the optimal cut-off value of plasma fibrinogen was 3.14g/L. High level of plasma fibrinogen was related to the poor prognosis of patients with BCa, and plasma fibrinogen has a more accurate prognostic ability than other plasma coagulation and fibrinolysis system factors. Multivariate Cox regression analysis showed that plasma fibrinogen was an independent predictor of OS (>3.14 vs ≤3.14 HR, 2.58, 95% CI = 1.28–5.23; p = 0.008) and DFS (>3.14 vs ≤3.14 HR, 2.60, 95% CI = 1.20–5.65; p = 0.016), and the nomogram based on plasma fibrinogen had better accuracy and discrimination (area under the curve (AUC): OS = 0.741, DFS = 0.733).ConclusionPlasma fibrinogen can be used as an independent predictor of OS and DFS for RC patients, and the nomogram based on plasma fibrinogen was a reliable model for predicting the prognosis after RC.

Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC).

Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.

Prospective associations of sleep apnea, periodic limb movements, and plasma fibrinogen level.

Our previous cross-sectional study showed that periodic limb movements during sleep (PLMS) were frequently found in patients with obstructive sleep apnea (OSA) and that both OSA and PLMS were associated with higher plasma fibrinogen levels. We explored the longitudinal relationships among these factors. Plasma fibrinogen levels were measured in 333 consecutive patients who underwent polysomnography to diagnose OSA. Patients who initiated continuous positive airway pressure (CPAP) underwent follow-up polysomnography after 3months of CPAP use. They were categorized into groups with good or poor adherence (% days with ≥ 4h/night of CPAP use ≥ 70% or < 70%, respectively). Changes in sleep parameters and plasma fibrinogen levels during the treatment period were compared between these groups. The cross-sectional analysis of all reviewed 333 patients indicated that fibrinogen levels were associated with the severities of OSA and PLMS. The 60 patients (27 good and 33 poor adherence) who underwent follow-up polysomnography were included in the longitudinal analysis. The median (interquartile range) periodic limb movement index did not change significantly from CPAP titration to the 3-month follow-up (good adherence: 10.5 (0-23.8) to 10.8 (0-70.2) events/h, p = 0.21; poor adherence: 1.2 (0-14.3) to 0.8 (0-15.7) events/h, p = 0.67). However, the plasma fibrinogen level significantly decreased only in the good adherence group (good adherence: baseline 275 ± 46 to follow-up 255 ± 47mg/dl, p < 0.01; poor adherence: 277 ± 52 to 284 ± 70mg/dl, p = 0.48). These results did not support a longitudinal association between PLMS and OSA. However, good adherence to CPAP could reduce plasma fibrinogen levels, thus ameliorating elevations in plasma fibrinogen as a risk factor for future cardiovascular events.

High levels of plasma fibrinogen and prothrombin time are related to post-stroke emotional impairment

IntroductionStudies have shown that high levels of the fibrinogen (FIB) are related to anxiety and depression. However, the relationship between FIB and post-stroke emotional impairment (PSEI) remains unclear, which includes post-stroke anxiety (PSA) and post-stroke depression (PSD). MethodsA total of 555 patients with acute ischemic stroke (AIS) were enrolled in this study. Ultimately, 443 patients completed 1‐month follow‐up. Blood samples were collected at hospital admission. Clinical depression and anxiety were evaluated 1 month after stroke. ResultsHigh levels of FIB were observed in patients with PSEI compared with the non‐EI group (p = 0.003). Levels of FIB were divided into three tertiles, and the prevalence of PSEI was significantly higher in the third FIB tertile (p = 0.016). After adjusting potential confounders, the third FIB tertile was independently associated with the prevalence of PSEI (OR = 1.785, 95%CI = 1.049–3.039, p = 0.033), taking the first tertile as a reference. In this model, prothrombin time (PT) was also independently associated with the prevalence of PSEI (OR = 1.602, 95%CI = 1.181–2.173, p = 0.002). ConclusionHigh levels of plasma FIB and PT are associated with the prevalence of PSEI.

The prognostic value of plasma fibrinogen level in patients with acute myeloid leukemia: a systematic review and meta-analysis

Increasing evidence has revealed that plasma fibrinogen levels may serve as prognostic indicators in patients with acute myeloid leukemia (AML), yet the exact association is still elusive. We conducted a systematic review and meta-analysis of all available studies concerning the relationship between plasma fibrinogen level and survival in AML patients. The pooled hazard ratio (HR) and 95% confidence intervals (CIs) for overall survival (OS) were calculated to evaluate the effect. A random-effect model was applied and the robustness of the pooled results was confirmed by subgroup and sensitivity analysis. A total of 9 studies were eligible to assess the association between plasma fibrinogen level and prognosis in AML. Among these investigations above, 5 studies adopted OS as their outcome indicator and were selected for the final meta-analysis. The pooled result suggested that plasma fibrinogen level was significantly relevant to increased mortality risk in AML patients (HR = 1.21, 95% CI: 1.01–1.44, p = .000, I2=85.4%). In conclusion, high plasma fibrinogen level may independently predict worse OS in patients with AML.

The association between the insertion/deletion polymorphism of the angiotensin-converting enzyme gene and the plasma fibrinogen level in women and men with premature coronary artery atherosclerosis.

The insertion/deletion (I/D) polymorphism of the angiotensin‑converting enzyme (ACE) gene is associated with younger age at coronary artery disease (CAD) onset. Some data indicate the relationship between the DD genotype and the fibrinogen level. At the same time, the regulation of the renin-angiotensin system differs in women and men. The objective of the study was to evaluate the sex‑dependentassociation of the ACE I/D polymorphism with the plasma fibrinogen level in patients with premature CAD. The study included 407 participants with premature CAD: 257 women not older than 55 years and 150 men not older than 45 years. Study participants had at least 1 stenosis ≥50% in a major epicardial coronary artery. The ACE I/D polymorphism (rs4343) was genotyped using polymerase chain reaction. Fibrinogen levels were measured with a modified Clauss method. We found a significant interaction indicating that sex modifies the influence of the I/D polymorphism of the ACE gene on fibrinogen levels (P = 0.02). The highest mean fibrinogen level, adjusted for age and smoking status, was observed in women with the DD genotype (575.7 mg/dl) and it was significantly higher than in men with the DD genotype (367.1 mg/dl; P <0.001) or in women with the ID genotype (491.7 mg/dl; P = 0.04). In men, there was no significant difference in mean adjusted fibrinogen levels across genotypes. The DD genotype of the ACE gene was associated with higher plasma fibrinogen levels in women with premature CAD yet not in men.

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.

High levels of plasma fibrinogen could predict frequent asthma exacerbations

High levels of plasma fibrinogen could predict frequent asthma exacerbations

High Preoperative Plasma Fibrinogen Independently Predicts a Poor Prognosis in Patients with Nonmetastatic RCC.

Background: This study aims to determine the relationship between preoperative plasma fibrinogen levels and the prognosis of patients with nonmetastatic renal cell carcinoma (RCC), including overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS).Methods: We retrospectively analysed the clinical data and prognostic information of 1194 nonmetastatic RCC patients who received radical nephrectomy or nephron-sparing surgery between 2005 and 2015 at our institution. Serum was collected for fibrinogen detection in the week prior to curative operation, and prognostic information was regularly collected by specially trained personnel. The cut-off value of the preoperative plasma fibrinogen level was defined by receiver operating characteristic (ROC) analysis. The chi-square test was used to analyse the association between preoperative fibrinogen level and clinical characteristics. Kaplan-Meier analysis was used to calculate survival curves, and significant differences were determined by the log-rank test. Other significant prognostic factors were evaluated by the Cox multivariate proportional hazard model.Results: The median follow-up period after radical or partial nephrectomy was 42.4 months (ranging from 0.433 to 146.37 months). The optimal preoperative plasma fibrinogen concentration was 3.975 g/L. The preoperative fibrinogen level was significantly associated with age, pathological T stage, sarcomatoid differentiation, necrosis and vein tumour thrombus (all p<0.05). High plasma fibrinogen levels were related to poor prognosis in terms of OS (p<0.001), CSS (p<0.001) and PFS (p<0.001). Multivariate analysis showed that the preoperative fibrinogen level remained an independent prognostic factor for OS (HR: 3.22, 95%CI: 1.87-5.55, p<0.001), CSS (HR: 4.12, 95%: 2.15-7.89, p<0.001) and PFS (HR: 3.137, 95%CI: 2.17-4.53, p<0.001).Conclusions: High preoperative plasma fibrinogen level is an independent negative prognostic factor for OS, CSS and PFS in patients with non-metastatic RCC. Preoperative plasma fibrinogen could be an ideal indicator for evaluating the outcomes of postoperative patients with nonmetastatic RCC.

Preoperative Plasma Fibrinogen and D-dimer as Prognostic Biomarkers for Non-Muscle-Invasive Bladder Cancer.

To assess the ability of preoperative plasma fibrinogen and D-dimer as biomarkers to predict survival outcomes in patients with non-muscle-invasive bladder cancer (NMIBC). A total of 206 NMIBC patients receiving transurethral resection of bladder tumor (TURBT) were assessed in our retrospective study. The cutoff values of fibrinogen and D-dimer were determined using receiver operating characteristic curve analysis. Cox regression analyses were adopted to assess the influence of these two parameters on recurrence-free survival (RFS) and progression-free survival (PFS). The cutoff values of fibrinogen and D-dimer were 3.56 g/L and 0.48 μg/mL, respectively. Kaplan-Meier analysis demonstrated that high fibrinogen and D-dimer levels were significantly related to poor RFS (all P< .001) and PFS (all P< .001). Moreover, patients with elevated fibrinogen levels tended to have high tumor grade (P= .033), advanced pathologic T stage (P< .001), and multiple tumor lesions (P= .019). Significant associations of high D-dimer levels with advanced pathologic T stage (P= .026), large tumor size (P= .012), and multiple tumor lesions (P= .006) were found. In addition, multivariate analysis revealed that plasma fibrinogen and D-dimer were all independent predictive factors for RFS (P= .029 and .001, respectively) and PFS (P= .023 and .003, respectively). High levels of preoperative plasma fibrinogen and D-dimer may indicate advanced clinicopathologic features and worse prognosis, suggesting that these two coagulation parameters could be used as prognostic biomarkers for NMIBC patients.

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.

Prognostic value of pretreatment plasma fibrinogen in patients with colorectal cancer: A systematic review and meta-analysis.

Background:Growing evidence showed that high pretreatment plasma fibrinogen could be used as a potential prognostic marker in colorectal cancer (CRC). However, the conclusions were controversial. Therefore, this meta-analysis was conducted to evaluate the prognostic value of pretreatment plasma fibrinogen in patients with CRC.Methods:Relevant studies were searched in the databases including PubMed, EMBASE, Web of Science, Cochrane library, and China National Knowledge Infrastructure up until December 10th, 2018. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to estimate the effects.Results:A total of 17 articles with 6863 patients were included in this meta-analysis. The results revealed that elevated pretreatment plasma fibrinogen was significantly associated with both poor overall survival (univariate analysis: HR = 1.69, 95% CI 1.47–1.95, P = .000; multivariate analysis: HR = 1.50, 95% CI 1.28–1.77, P = .000) and poor disease-free survival (univariate analysis: HR = 1.90, 95% CI 1.49–2.41, P = .000; multivariate analysis: HR = 2.08, 95% CI 1.52–2.86, P = .000) in patients with CRC.Conclusions:High pretreatment plasma fibrinogen level is significantly associated with worse survival outcomes in CRC patients. Plasma fibrinogen may be used as an effective prognostic marker and potential therapeutic target. Further studies are required to support these results.

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

Type IV collagen turnover is predictive of mortality in COPD: a comparison to fibrinogen in a prospective analysis of the ECLIPSE cohort

BackgroundIdentifying subjects with chronic obstructive pulmonary disease (COPD) at high risk of exacerbation and mortality is key to aid individual management of COPD. The only FDA approved blood-based drug development biomarker for patients at high risk of mortality, is plasma fibrinogen. In this study, we benchmarked two biomarkers of basement membrane remodeling, a characteristic of COPD, against plasma fibrinogen alone and as a combination. The biomarkers of basement membrane remodeling are two neoepitopes from of the alpha 3 chain of type IV collagen (COL4A3).Materials and methodsCOL4A3 degradation was assessed by the biomarkers C4Ma3 and tumstatin (TUM) in year 1 plasma samples in 984 COPD subjects, 95 non-smoking controls and 95 smoking controls from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort. They were measured by competitive ELISA using monoclonal antibodies recognizing two specific MMP-generated cleavage site within COL4A3. The level of fibrinogen was previously assessed in year 1 plasma.ResultsIn COPD subjects, plasma C4Ma3 levels were significantly correlated with plasma fibrinogen levels (0.389 (P < 0.0001)). Cox proportional-hazards regression adjusted for relevant confounders showed that high levels of plasma C4Ma3, but not TUM, were related to a higher risk of mortality (hazard ratio 5.12 (95% CI 2.28–11.50), P < 0.0001). High levels of plasma fibrinogen were not associated with all-cause mortality in this subpopulation, contradictory to published results. Whereas plasma C4Ma3 multiplied by fibrinogen showed to be related to a higher risk of mortality (hazard ratio 5.74 (95% CI 2.65–12.41), P < 0.0001). Plasma C4Ma3 levels were related to the number of hospitalizations due to COPD exacerbations in the year before study start (P = 0.0375). Fibrinogen levels were related to hospitalized exacerbations prior to study start (P = 0.0058) and were also related to future exacerbations (P < 0.0001).ConclusionWe compared herein fibrinogen, C4Ma3 and TUM as biomarkers for COPD prognosis. Fibrinogen was related to future exacerbation, whereas C4Ma3 and the combination of C4Ma3 with fibrinogen were superior to fibrinogen alone in predicting mortality. This pilot study suggests that the assessment of plasma C4Ma3 could be important for identifying COPD patients with a poor prognosis.Trial registrationNCT00292552, GSK Study No. SCO104960.

The Prognostic Value of Pretreatment Plasma Fibrinogen in Urological Cancers: A Systematic Review and Meta-analysis.

Objective:Growing evidence suggests pretreatment fibrinogen can serve as a prognostic marker in various malignancies. However, there are contradictory results about the prognostic role of fibrinogen in urological cancers. We conducted a meta-analysis to evaluate the association between pretreatment plasma fibrinogen and survival outcomes in urological cancers.Methods: After a systematic search of PubMed and Embase, we included 14 studies in our meta-analysis, and estimated hazard ratios (HRs) for overall survival (OS) and cancer-specific survival (CSS) using a fixed-effect model.Results: Our results indicate that pretreatment plasma fibrinogen is a prognostic factor in urological cancers (OS: HR=2.21, 95% CI=1.91-2.57, P<0.001, CSS: HR=2.67, 95% CI=2.23-3.19, P<0.001). Elevated pretreatment plasma fibrinogen is associated with poorer survival in prostate cancer (OS: HR=2.26, 95% CI=1.47-3.48, P<0.001; CSS: HR=2.42, 95% CI=1.44-4.07, P=0.001), renal cell carcinoma (OS: HR=2.13, 95% CI=1.75-2.61, P<0.001; CSS: HR=2.99, 95% CI=2.29-3.89, P<0.001) and upper tract urothelial carcinoma (OS: HR=2.34, 95% CI=1.81-3.02, P<0.001; CSS: HR=2.43, 95% CI=1.84-3.20, P<0.001). Subgroup analyses showed that plasma fibrinogen has a more negative impact on survival in Caucasian patients (OS: HR=2.52, 95% CI=1.95-3.25, P<0.001; CSS: HR=2.83, 95% CI=1.92-4.17, P<0.001) than Asian patients (OS: HR=2.07, 95% CI=1.73-2.49, P<0.001; CSS: HR=2.63, 95% CI=2.14-3.22, P<0.001). The prognostic value of fibrinogen is also consistent when stratified by different cut-off values.Conclusions: These results show that high pretreatment plasma fibrinogen levels can predict poorer OS and CSS in patients with urological cancers.

Феномен влечения к алкоголю и фибриноген

Введение. Фибриноген, как и многие белки системы гемостаза и фибринолиза, участвует во многих физиологических процессах, при этом его содержание может увеличиваться или уменьшаться при различных патологических состояниях, и эти модуляции часто служат диагностическим признаком заболевания. Цель исследования: определить уровень фибриногена и время лизиса эуглобулиновой фракции плазмы крови в зависимости от степени влечения к этанолу у крыс. Материалы и методы. Работа выполнена на 300 крысах-самцах линии Вистар весом 250–350 г, у которых после двух-недельного периода акклиматизации ежедневно в течение 7 дней проводили тестирование потребления 10% раствора этанола и воды в индивидуальных боксах. Эти жидкости были доступны в течение 23 часов без доступа к пище. Позиции 2 питьевых пипеток объемом 50 мл случайным образом менялись местами через каждые 24 часа. Результаты. Установлено, что чем выраженнее была исходная степень влечения к этанолу, тем выше оказывалось содержание фибриногена и ниже фибринолитическая активность. Заключение. Случаи повышенного содержания фибриногена у исходно отвергающих, не имевших контакта с этанолом крыс указывает на возможность генетически обусловленной гиперфибриногенемии, которая может стать источником предтромбозных состояний в случае предрасположенности к потреблению алкоголя в качестве энергетической самокоррекции. Introduction. Fibrinogen, like many proteins of hemostasis and fi brinolysis system, participates in many physiological processes, and its content may increase or decrease under various pathological conditions, and these modulations often serve as a diagnostic sign of the disease. Aim: to determine fi brinogen level and euglobulin lysis time as function of attraction degree to ethanol in rats. Materials and methods. The work was performed on male Wistar rats (n = 300) weighing 250–350 g. After 2 weeks of acclimatization the consumption of 10% ethanol and water in individual boxes was daily tested for 7 days. These fl uids were available for 23 hours without access to food. Positions of 2 drinking pipettes of 50 ml volume randomly changed every 24 hours. Results. It was found that fi brinogen content was higher but fi brinolytic activity was lower in rats with more expressed initial degree of attraction to ethanol. Conclusion. The cases of increased fi brinogen content in initially refused rats that did not contact with ethanol indicate the possibility of genetically determined hyperfi brinogenemia that can become a source of prethrombotic conditions in case of predisposition to alcohol consumption as an energy self-correction.

Relationships between plasma fibrinogen and prognosis and tumor metastasis in patients with nasopharyngeal carcinoma

Objective To investigate the relationships between the plasma fibrinogen level before treatment and prognosis and tumor metastasis in patients with nasopharyngeal carcinoma. Methods The clinical data of 817 patients with non-distant metastasis nasopharyngeal carcinoma from January 2005 to October 2014 in our hospital were collected. All the patients were followed up, and the median follow-up time was 37.6 months. The critical value of plasma fibrinogen before treatment was determined by receiver operating characteristic (ROC) curve. The overall survival (OS) and distant metastasis free survival (DMFS) and their relevant factors were analyzed by Kaplan-Meier and Cox regression model. Results The critical value of plasma fibrinogen before treatment was 3.314 g/L determined by ROC curve analysis. The plasma fibrinogen level before treatment was related to the TNM stage (χ2=6.048, P=0.014), T stage (χ2=13.764, P<0.001) and distant metastasis after treatment (χ2=14.637, P<0.001). Survival analysis showed that the 3-year OS rate and 3-year DMFS rate in patients with plasma fibrinogen level ≥3.314 g/L before treatment were significantly lower than those in patients with plasma fibrinogen level <3.314 g/L, with significant differences (87.2% vs. 95.6%, χ2=4.562, P<0.001; 71.1% vs. 82.2%, χ2=5.153, P<0.001). Cox multivariate analysis showed that high level of plasma fibrinogen before treatment (HR=1.961, 95%CI: 1.332-2.917, P=0.001), EB virus DNA (HR=1.929, 95%CI: 1.275-2.849, P=0.001) and pretreatment stage (HR=1.653, 95%CI: 1.013-2.709, P=0.045) were the independent influencing factors of OS. The high level of plasma fibrinogen before treatment (HR=1.519, 95%CI: 1.142-1.964, P=0.002) and EB virus DNA (HR=1.950, 95%CI: 1.483-2.555, P<0.001) were the independent influencing factors of DMFS. Of the 817 patients, 179 patients (21.91%) had metastasis during the follow-up period, and 159 patients (88.83%) had metastasis within 3 years after treatment. The plasma fibrinogen level before treatment in 638 patients without metastasis (3.197±1.009) was significantly lower than that in 179 patients with metastasis (3.351±1.042; t=5.089, P=0.024), and was significantly lower than that in 87 patients with bone metastasis (3.430±1.004; t=6.752, P=0.009), 68 patients with pulmonary metastasis (3.301±1.018; t=4.281, P=0.039) and 71 patients with liver metastasis (3.413±1.107; t=6.398, P=0.011). Conclusion The plasma fibrinogen level before treatment can be used as an independent index to predict the prognosis of patients with nasopharyngeal carcinoma, which is related to tumor metastasis. Key words: Fibrinogen; Nasopharyngeal neoplasms; Metastasis; Prognosis

Risk Factors Associated with the Outcome of Post-Traumatic Hydrocephalus.

Post-traumatic hydrocephalus is a common complication that arises after head injury. However, risk factors associated with the outcome of post-traumatic hydrocephalus have seldom been addressed. Therefore, we performed this clinical study to analyze the risk factors affecting the outcome of post-traumatic hydrocephalus in patients with head injuries. A total of 116 post-traumatic hydrocephalus patients, admitted in our hospital between March 2012 and October 2017 were reviewed. The related factors assessed were age, gender, Glasgow Coma Score on admission, platelet count, plasma fibrinogen levels, D-dimer concentration, subarachnoid hemorrhage, subdural hygroma, cerebral hernia, cisterna ambiens, decompressive craniectomy, cranioplasty, ventriculoperitoneal shunt implantation, intracranial infection, and duration of comatous state. The patient outcomes after 6 months of treatment were evaluated by the Glasgow Outcome Scale. Risk factors for the outcome of post-traumatic hydrocephalus were evaluated by applying logistic regression analysis. Poor outcome was observed in 66.4% of the patients (77/116). Univariate and multivariate analyses revealed that the disappearance of cisterna ambiens, the long duration of comatous state (>2 months), the high levels of plasma fibrinogen, and the ventriculoperitoneal shunt implantation were related to adverse outcomes (p < 0.05). The disappearance of cisterna ambiens, the prolonged duration of comatous state (>2 months), the high plasma fibrinogen levels are the most important factors affecting the outcome of post-traumatic hydrocephalus, and the ventriculoperitoneal shunt implantation is the most critical predictor of the outcome of post-traumatic hydrocephalus.

Prognostic value of plasma fibrinogen in hepatocellular carcinoma: a meta-analysis

BackgroundElevated plasma fibrinogen levels have been associated with tumor progression in several malignancies. Our study aims to characterize the clinical significance of elevated plasma fibrinogen levels in patients with hepatocellular carcinoma (HCC).Materials and methodsRelevant published articles were systematically searched in electronic databases including PubMed, Embase, and Web of Science. The pooled differences in plasma fibrinogen levels among HCC, cirrhotic, and control groups were expressed as weighted mean differences (WMDs) and their corresponding 95% CIs. The associations between elevated fibrinogen and overall survival (OS) and disease-free survival (DFS)/recurrence-free survival (RFS) were expressed as HRs and their 95% CIs, whereas the associations between elevated fibrinogen and various types of clinical characteristic of patients with HCC were expressed as ORs and their corresponding 95% CIs.ResultsResults showed that the plasma fibrinogen levels in patients with HCC were not significantly different than that in healthy controls (WMD = 0.50, 95% CI = [−0.82, 1.82], P = 0.457) or patients with cirrhosis (WMD = −0.62, 95% CI = [−1.56, 0.33], P = 0.200). However, our results showed that compared to those with normal levels, patients with HCC and elevated plasma fibrinogen levels showed poorer OS (HR = 2.08, 95% CI = [1.67, 2.59], P < 0.0001) and DFS/RFS (HR = 1.90, 95% CI = [1.52, 2.37], P < 0.0001). Results of trial sequential analysis of the OS indicated that currently available studies were sufficient to validate the negative prognostic value of elevated plasma fibrinogen in patients with HCC. Clinicopathological analyses showed that high plasma fibrinogen levels were associated with tumor progression as indicated by advanced tumor stage, larger tumor size, increased tumor number, and the presence of vascular invasion.ConclusionElevated plasma fibrinogen levels are associated with poor prognosis and advanced tumor progression. Plasma fibrinogen may serve as a negative prognostic biomarker in patients with HCC.

Prognostic significance of pretreatment plasma fibrinogen level in patients with digestive system tumors: a meta-analysis.

High pretreatment levels of plasma fibrinogen have been widely reported to be a potential predictor of prognosis in digestive system tumors; however, the conclusions are not consistent. Therefore, we performed a meta-analysis to comprehensively assess the prognostic roles of high pretreatment plasma fibrinogen levels in digestive system tumors. We searched for eligible studies in the PubMed, Embase, and Web of Science electronic databases for publications from the database inception to 1 September 2017. The endpoints of interest included overall survival, disease-free survival, and recurrence-free survival. We investigated the relationship between fibrinogenemia and overall survival in colorectal cancer (10 studies), gastric cancer (6), pancreatic cancer (6), hepatocellular carcinoma (7), and esophageal squamous cell carcinoma (10); the pooled results indicated that fibrinogenemia was significantly related to a worse overall survival (hazard ratio (HR) 1.73; 95% confidence interval (CI) 1.52, 1.97; P <0.001; HR 1.71; 95% CI 1.28, 2.28; P <0.001; HR 1.57; 95% CI 1.13, 2.17; P = 0.007; HR 1.89; 95% CI 1.57, 2.27; P <0.001, and HR 1.67; 95% CI 1.35, 2.07; P <0.001). Taken together, an increased pretreatment plasma fibrinogen level was related to worse survival in digestive system tumors, indicating that it could be a useful prognostic marker in these types of tumors.