Preoperative Plasma Fibrinogen Concentration Research Articles

Prognostic value of the preoperative fibrinogen-to-albumin ratio in pancreatic ductal adenocarcinoma patients undergoing R0 resection.

BACKGROUNDInflammation plays an important role in tumor progression, and growing evidence has confirmed that the fibrinogen-to-albumin ratio (FAR) is an important prognostic factor for overall survival in malignant tumors.AIMTo investigate the prognostic significance of FAR in patients undergoing radical R0 resection of pancreatic ductal adenocarcinoma (PDAC).METHODSWe retrospectively analyzed the data of 282 patients with PDAC who underwent radical R0 resection at The Cancer Hospital of the Chinese Academy of Medical Sciences from January 2010 to December 2019. The surv_cutpoint function of the R package survminer via RStudio software (version 1.3.1073, http://www.rstudio.org) was used to determine the optimal cut-off values of biological markers, such as preoperative FAR. The Kaplan-Meier method and log-rank tests were used for univariate survival analysis, and a Cox regression model was used for multivariate survival analysis for PDAC patients who underwent radical R0 resection.RESULTSThe optimal cut-off value of FAR was 0.08 by the surv_cutpoint function. Higher preoperative FAR was significantly correlated with clinical symptoms (P = 0.001), tumor location (P < 0.001), surgical approaches (P < 0.001), preoperative plasma fibrinogen concentration (P < 0.001), and preoperative plasma albumin level (P < 0.001). Multivariate analysis showed that degree of tumor differentiation (P < 0.001), number of metastatic lymph nodes [hazard ratio (HR): 0.678, 95% confidence interval (CI): 0.509-0.904, P = 0.008], adjuvant therapy (HR: 1.604, 95%CI: 1.214-2.118, P = 0.001), preoperative cancer antigen 19-9 level (HR: 1.740, 95%CI: 1.288-2.352, P < 0.001), and preoperative FAR (HR: 2.258, 95%CI: 1.720-2.963, P < 0.001) were independent risk factors for poor prognosis in patients with PDAC who underwent radical R0 resection.CONCLUSIONThe increase in preoperative FAR was significantly related to poor prognosis in patients undergoing radical R0 resection for PDAC. Preoperative FAR can be used clinically to predict the prognosis of PDAC patients undergoing radical R0 resection.

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

BackgroundOne of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed.The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI.MethodsA total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed.ResultsPS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002–1.013, p = 0.013).ConclusionsAlthough protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

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.

A scoring model based on plasma fibrinogen concentration for predicting recurrence of hepatocellular carcinoma after liver transplantation

BackgroundWe investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence. MethodsCox regression analysis was used to identify factors that predicted tumor recurrence, and a scoring model was generated by assigning a value of 0 or 1 to each independent risk factor. The cut-off value for fibrinogen was determined by receiver operating characteristic curve analysis. ResultsPreoperative fibrinogen concentration was significantly higher in patients with vs. without tumor recurrence (3.27 g/L vs. 2.34 g/L, P < 0.001), with vs. without macrovascular invasion (3.54 g/L vs. 2.82 g/L, P = 0.007), and with >400 vs. ≤400 ng/mL plasma alpha-fetoprotein concentration (3.43 g/L vs. 2.76 g/L, P = 0.007). The 5-year disease-free survival rate was significantly lower for patients with elevated (≥2.68 g/L) vs. normal (<2.68 g/L) fibrinogen concentration (37.2% vs. 78.4%, P = 0.001). Macrovascular invasion, >3 tumor nodules, and elevated fibrinogen concentration were independent risk factors for tumor recurrence. A scoring model based on these risk factors predicted recurrence with a sensitivity of 68.3% and a specificity of 87.5%. ConclusionsElevated preoperative plasma fibrinogen concentration is associated with tumor recurrence in HCC patients after liver transplantation. A new scoring model predicted recurrence with good sensitivity and specificity.

Relationship Between Preoperative Plasma Fibrinogen Concentration, Perioperative Bleeding, and Transfusions in Elective Adult Spinal Deformity Correction

Study DesignRetrospective analysis. ObjectiveThis study sought to investigate the relationship between preoperative (preop) fibrinogen, bleeding, and transfusion requirements in adult spinal deformity corrections. Summary of Background DataBlood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss. MethodsData were collected from clinic charts and hospital medical records of all 142 of a single surgeon's consecutive adult spine patients undergoing 7 or more levels deformity correction surgeries from January 2011 to December 2014. t tests were used to compare perioperative variables between patients with total blood loss in the upper quartile (≥1,000 mL) and the remaining patients. Similarly, patients receiving >2 units of packed red cells (PRCs) were compared with others. Analysis of variance was used to compare the blood loss between the patients' groups (quartiles) based on their preoperative fibrinogen concentration. ResultsMean total blood loss was 847.9 (±543.6) mL. Overall, mean preoperative fibrinogen concentration was 254.8 (±82.9) mg/dL. Patients with lower fibrinogen concentration (<193 mg/dL) experienced significantly higher blood loss than those with higher concentrations (p < .05). Patients with transfusion >2 units PRC had significantly greater number of spinal levels treated, higher mean operative time, total blood loss and lower mean preoperative fibrinogen than those transfused 2 or fewer units PRC (p < .05). Total blood loss correlated significantly with preoperative fibrinogen concentration (r = −0.51, p < .05). All the thromboelastography (TEG) variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p < .05). ConclusionsIn our cohort undergoing correction of adult spinal deformity, patients with preoperative fibrinogen level lower than 193 mg/dL had significantly higher bleeding than their counterparts. Perioperative transfusion requirements correlated moderately both with the blood loss and preoperative fibrinogen concentration. Incorporation of preoperative fibrinogen allows better prediction of total perioperative blood loss and may therefore guide the treatment team in use of ameliorating therapies. Level of EvidenceLevel IV.

Combination of preoperative plasma fibrinogen and AJCC staging improves the accuracy of survival prediction for patients with stage I-II gastric cancer after curative gastrectomy.

This study aimed to determine the prognostic value of preoperative plasma fibrinogen concentration (PFC) in patients with stage I‐II gastric cancer after curative gastrectomy. The preoperative PFC and clinicopathological data of 793 patients with stage I‐II gastric cancer who underwent curative gastrectomy were analyzed retrospectively. PFC of <4.0 g/L and ≥4.0 g/L were considered as PFC0 and PFC1, respectively. The association between PFC and the clinicopathological features of gastric cancer and the value of PFC in survival prediction were investigated. PFC1 indicated poorer overall survival and cancer‐specific survival among patients with tumor‐node‐metastasis (TNM) stage I‐II, and PFC was identified as an independent indicator of survival via multivariate analysis. Importantly, PFC stage was proven to be an independent prognostic factor for stage I and T1‐4aN0 gastric cancer. PFC stage combined with the American Joint Committee on Cancer (AJCC)‐TNM stage has better accuracy for predicting disease prognosis than AJCC‐TNM stage alone. The prognosis of patients with stage I‐II gastric cancer can be further stratified by PFC level. For patients with stage I gastric cancer, PFC1 can be considered a high‐risk prognostic factor, and adjuvant chemotherapy should be recommended for patients with PFC1.

Association of preoperative plasma fibrinogen level with postoperative bleeding after on-pump coronary bypass surgery: does plasma fibrinogen level affect the amount of postoperative bleeding?

Our primary aim was to investigate the association between the preoperative concentration of plasma fibrinogen and the volume of postoperative bleeding. Our secondary aim was to identify whether there is a possible correlation between the patients' different characteristics and haemostatic laboratory variables and the postoperative amount of bleeding after on-pump coronary artery bypass grafting procedures. A total of 550 adult patients undergoing isolated coronary artery bypass grafting on cardiopulmonary bypass in our hospital were enrolled and investigated retrospectively. The total amount of chest tube drainage within the first 24 postoperative hours or until the patient was re-explored for bleeding was assessed. Excessive bleeding was defined as more than 500 ml drainage in the first 24 h. The patients were divided into 2 groups: Group 1: the patients who bled ≤500 ml in the first 24 h and Group 2: the patients who bled >500 ml in the first 24 h. A preoperative fibrinogen threshold associated with excessive bleeding was investigated by receiver operating characteristic curve analyses, revealing a calculated cutoff value of 3.1 g/l. Risk factors for increased bleeding were analysed by a logistic regression model that revealed male gender (P < 0.001), body mass index ≤28.3 kg/m2 (P < 0.001), platelet count ≤233 × 103/µl (P < 0.001), estimated glomerular filtration rate ≤90.8 ml/min (P < 0.001) and fibrinogen ≤3.1 g/l (P = 0.01) as significant predictors. A preoperative plasma fibrinogen concentration <3.1 g/l was associated with increased risk of excessive bleeding in patients undergoing on-pump coronary artery bypass grafting. The amount of postoperative blood loss can be roughly predicted with simple preoperative blood tests.

Low Fibrinogen Is Associated with Increased Bleeding-Related Re-exploration after Cardiac Surgery.

Re-exploration after cardiac surgery remains a relatively frequent complication associated with adverse effects on outcome. We aimed to identify risk factors for re-exploration. We retrospectively reviewed 2,403 patients having undergone cardiac surgical procedure between January 2013 and December 2014. Re-exploration was required in 114 patients (4.7%). Patients with oral anticoagulation, infective endocarditis, or a clearly identified bleeding source were excluded. Therefore, 42 patients remained for analysis. A matched cohort was selected for age, sex, ejection fraction, creatinine, and procedure out of the non-re-explored patients. Demographic data were similar in both groups, except for a higher prevalence of diabetes (45 vs. 21%; p = 0.036) in the non-re-explored patients. Surgery was elective in two-thirds and preoperative plasma fibrinogen concentration was lower in patients requiring re-exploration (2.8 ± 0.9 vs. 3.6 ± 0.9 g/L; p = 0.002). During the initial operation, re-explored patients received more packed red blood cells (1.5 ± 3 vs. 0 ± 1 units; p < 0.001), Postoperatively, re-explored patients had higher lactate levels (1.7 ± 1.4 vs. 1.3 ± 0.6 mmol/L, p = 0.044), more chest tube drainage (1,245 ± 948 vs. 685 ± 413 mL; p < 0.001), higher hospital mortality (19 vs. 7%; p = 0.19), and longer intensive care unit (ICU) stays (8 ± 8 vs. 4 ± 7 days; p = 0.010). In addition, more fibrinogen was administrated during the initial surgery. Plasma fibrinogen concentration upon arrival at the ICU was lower in patients requiring re-exploration (2 ± 0.6 vs. 2.7 ± 0.7 g; p < 0.001). Multivariable linear regression analysis identified fibrinogen upon arrival at the ICU as an independent predictor of postoperative bleeding. Cardiac surgery patients with low perioperative plasma fibrinogen concentration appear to be more susceptible to bleeding and re-exploration. Re-exploration in this group of patients is associated with increased morbidity and mortality.

Preoperative plasma fibrinogen concentration, factor XIII activity, perioperative bleeding, and transfusions in elective orthopaedic surgery: A prospective observational study

BackgroundMajor orthopaedic surgery involves a calculated risk of bleeding. In other groups of surgical patients, low preoperative plasma fibrinogen concentration and factor XIII (FXIII) activity have been associated with an elevated risk of bleeding. In the present study we investigated the association between preoperative fibrinogen plasma concentration and FXIII activity on bleeding and transfusion requirements in patients undergoing a spinal fusion procedure or hip or knee arthroplasty. MethodsTwo hundred and forty-five adult patients undergoing spine fusion surgery (n=52), total unilateral primary hip arthroplasty (n=114), or total knee arthroplasty (n=79) were included in a prospective observational study. Blood samples were collected <24h before surgery and analysed for fibrinogen concentration and FXIII activity. Intraoperative and postoperative bleeding volume and transfusion requirements were recorded. ResultsSpinal fusion surgery patients with a low preoperative fibrinogen concentration (≤2.5g/L) had a greater total perioperative median bleeding volume than patients with fibrinogen>2.5g/L (2430 (400–6560) mL vs. 1390 (400–7420) mL, p=0.029). No significant association between low fibrinogen levels and perioperative bleeding volume was observed for arthroplasty patients. There was no association between low fibrinogen levels and transfusion requirements in any of the groups. Low FXIII activity was not significantly associated with bleeding volume and transfusion requirements in any group. ConclusionMeasurement of preoperative fibrinogen plasma concentration can identify spinal fusion patients with an increased risk of excessive perioperative bleeding. Measurement of FXIII activity cannot identify orthopaedic patients with elevated risk of bleeding.

Prognostic significance of preoperative plasma fibrinogen in endometrial cancer

Objective To investigate the prognostic significance of preoperative plasma fibrinogen concentration, with particular focus on tumor dissemination and nodal involvement, in a substantial cohort of patients with endometrial cancer. Methods The study population comprised 336 women with endometrial cancer who underwent surgical staging at two tertiary institutions, from 2000 to 2009. Pretreatment plasma samples from the study cohort were assayed for fibrinogen by the Clauss assay. Information on demographics, laboratory testing, histopathology and follow-up was gathered from databases of prospectively collected data. Factors associated with survival were identified in a Cox proportional hazards model. Univariate and multivariate analyses were used to evaluate predictors of extrauterine disease and nodal metastasis. Results One-hundred-thirty-seven (40.8%) patients exhibited preoperative hyperfibrinogenemia. Univariate analysis demonstrated that histological type, tumor grade, depth of myometrial invasion, surgical stage, patient age, and hyperfibrinogenemia affect disease-free (DFS) and overall survival rates significantly. When these variables were entered simultaneously into a Cox regression model, raised preoperative levels of plasma fibrinogen retained significance as poor prognosticator of DFS (HR 2.0, 95%CI 1.1–3.6) and overall survival (HR 2.7, 95%CI 1.3–5.5). Preoperative hyperfibrinogenemia was an independent determinant of extrauterine disease (OR 2.7, 95%CI 1.3–5.6). In the subcohort of women with endometrioid histology, increased fibrinogen concentration at presentation was predictive of pelvic nodal involvement (OR 3.6, 95%CI 1.1–11.7). Conclusion Plasma fibrinogen level may be of value in the prediction of outcome, improve the stratification of endometrial cancer patient, at diagnosis, based on their risk of recurrence, and possibly alter their treatment accordingly.