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Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation. Thromb Res 2023; 229:219-224. [PMID: 37562164 DOI: 10.1016/j.thromres.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The D-dimer to fibrinogen ratio (DFR) is a good indicator of clot-producing activity in thrombotic disease, but its clinical usefulness in stroke patients with nonvalvular atrial fibrillation (NVAF) has not been studied. We evaluated the association between the DFR and early neurological deterioration (END) in acute ischemic stroke (AIS) patients with NVAF. METHODS We included consecutive AIS patients with NVAF between 2013 and 2015 from the registry of a real-world prospective cohort from 11 large centers in South Korea. END was defined as an increase ≥2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. The DFR was calculated as follows: DFR = D-dimer (mg/L)/fibrinogen (mg/dL) x 100. RESULTS A total of 1018 AIS patients with NVAF were evaluated. In multivariable logistic regression analysis, the highest DFR tertile was closely associated with END (adjusted odds ratio [aOR] = 2.14, 95 % confidence interval [CI]: 1.24-3.69). Hypertension (aOR = 1.71, 95 % CI: 1.09-2.70), initial NIHSS score (aOR = 1.05, 95 % CI: 1.02-1.07) and use of anticoagulants (aOR = 0.41, 95 % CI: 0.28-0.60) were also correlated with END. In addition to END, the DFR was correlated with discharge NIHSS and modified Rankin Scale (mRS) scores and the 3-month mRS score. CONCLUSIONS High DFR values were associated with END in AIS patients with NVAF. As the DFR is an indicator directly related to the main pathological mechanism of NVAF patients (fibrinolysis and coagulation), it may be useful in predicting their prognosis.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Departement of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
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Wang C, Yu X, Wang T, Ding M, Ran L. D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury. Spinal Cord 2023; 61:447-452. [PMID: 37380758 DOI: 10.1038/s41393-023-00905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the predictive value of D-dimer/fibrinogen (D/F) ratio for deep vein thrombosis (DVT) in patients with traumatic spinal cord injury (SCI). SETTING Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University. METHODS SCI patients within 24 h of trauma were consecutively enrolled. DVT was diagnosed by DUS examination during hospitalization. Multivariable logistic regression analysis was performed to determine the relationship between D/F ratio and DVT. Stratified logistic regression analysis was performed to identify effect modifiers. The receiver operating characteristic (ROC) curve was conducted to assess the predictive value of D/F ratio. RESULTS A total of 284 patients with SCI were included, of whom 106 (37.3%) developed DVT. D/F ratio was positively correlated with DVT (OR 1.17, 95% confidence interval [CI] 1.04-1.31, p = 0.009). Patients in the upper D/F ratio tertile (3.15-18.27) had a higher risk of DVT than patients in the lower tertile (0.08-0.97) after adjustment for potential confounders (OR 6.01, 95% CI 2.24-16.15, p < 0.001). The risk of DVT increased stepwise across D/F ratio tertiles (p for trend = 0.003). The area under the ROC curve (AUC) was 0.758 (95% CI 0.704-0.806). There was a significant interaction between D/F ratio and neurological level of injury (p for interaction = 0.003) and the association between D/F ratio and DVT remained significant only in patients with cervical injury. CONCLUSIONS A higher D/F ratio was independently associated with a higher risk of DVT in a dose-dependent manner in patients with cervical SCI.
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Affiliation(s)
- Changyi Wang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xi Yu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiantian Wang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingfu Ding
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyu Ran
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Janus SE, Hajjari J, Chami T, Mously H, Badhwar AK, Karnib M, Carneiro H, Rahman M, Al-Kindi SG. Multi-variable biomarker approach in identifying incident heart failure in chronic kidney disease: results from the Chronic Renal Insufficiency Cohort study. Eur J Heart Fail 2022; 24:988-995. [PMID: 35587997 DOI: 10.1002/ejhf.2543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality in the ever-growing population of patients with chronic kidney disease (CKD). There is a need to enhance early prediction to initiate treatment in CKD. We sought to study the feasibility of a multi-variable biomarker approach to predict incident HF risk in CKD. METHODS AND RESULTS We examined 3182 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) without prevalent HF who underwent serum/plasma assays for 11 blood biomarkers at baseline visit (B-type natriuretic peptide [BNP], CXC motif chemokine ligand 12, fibrinogen, fractalkine, high-sensitivity C-reactive protein, myeloperoxidase, high-sensitivity troponin T (hsTnT), fibroblast growth factor 23 [FGF23], neutrophil gelatinase-associated lipocalin, fetuin A, aldosterone). The population was randomly divided into derivation (n = 1629) and validation (n = 1553) cohorts. Biomarkers that were associated with HF after adjustment for established HF risk factors were combined into an overall biomarker score (number of biomarkers above the Youden's index cut-off value). Cox regression was used to explore the predictive role of a biomarker panel to predict incident HF. A total of 411 patients developed incident HF at a median follow-up of 7 years. In the derivation cohort, four biomarkers were associated with HF (BNP, FGF23, fibrinogen, hsTnT). In a model combining all four biomarkers, BNP (hazard ratio [HR] 2.96 [95% confidence interval 2.14-4.09]), FGF23 (HR 1.74 [1.30-2.32]), fibrinogen (HR 2.40 [1.74-3.30]), and hsTnT (HR 2.89 [2.06-4.04]) were associated with incident HF. The incidence of HF increased with the biomarker score, to a similar degree in both derivation and validation cohorts: from 2.0% in score of 0% to 46.6% in score of 4 in the derivation cohort to 2.4% in score of 0% to 43.5% in score of 4 in the validation cohort. A model incorporating biomarkers in addition to clinical factors reclassified risk in 601 (19%) participants (352 [11%] participants to higher risk and 249 [8%] to lower risk) compared with clinical risk model alone (net reclassification improvement of 0.16). CONCLUSION A basic panel of four blood biomarkers (BNP, FGF23, fibrinogen, and hsTnT) can be used as a standalone score to predict incident HF in patients with CKD allowing early identification of patients at high-risk for HF. Addition of biomarker score to clinical risk model modestly reclassifies HF risk and slightly improves discrimination.
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Affiliation(s)
- Scott E Janus
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jamal Hajjari
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tarek Chami
- Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Haytham Mously
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anshul K Badhwar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohamad Karnib
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Herman Carneiro
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Zhang L, Jiang J, Li J, Wang M, Zhou J. Prognostic value of D-dimer to fibrinogen ratio for patients with acute myocardial infarction. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221132381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective Myocardial infarction is a severe disease with high in-hospital mortality without aggressive clinical treatment. The study aims to evaluate prognostic worth of D-dimer-to-fibrinogen (FIB) ratio (DFR) for patients with acute myocardial infarction (AMI). Methods 133 patients (65 (37, 93) years old) from our hospital (China) with AMI were enlisted from January 2017 to December 2019. Patients were assigned into the survivor and nonsurvivor group based on in-hospital outcomes. Receiver operating characteristics (ROC) and multivariate analysis were fulfilled to analyze the prognostic value of DFR. Results The degree of DFR in the nonsurvivor group was significantly higher than that in the survivor group ( p < 0.05). Logistic regression analysis presented that DFR (hazard ratio (HR), 2.207; 95% confidence interval (CI), 1.050–4.640; p = 0.037) was independently related with in-hospital death. ROC demonstrated that the area under the curve (AUC) of DFR was = 0.808 (0.725–0.892) (sensitivity, 85.3%; specificity, 69.7%). Conclusion DFR might be a new independent predictor of in-hospital death for AMI patients. Further studies are needed to validate this preliminary finding.
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Affiliation(s)
- Litao Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, China
- Branch of National Clinical Research Center for Laboratory Medicine, China
| | - Jiahong Jiang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, China
- Branch of National Clinical Research Center for Laboratory Medicine, China
| | - Jie Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, China
- Branch of National Clinical Research Center for Laboratory Medicine, China
| | - Min Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, China
- Branch of National Clinical Research Center for Laboratory Medicine, China
| | - Jun Zhou
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, China
- Branch of National Clinical Research Center for Laboratory Medicine, China
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Murat S, Murat B, Dural M, Mert GO, Cavusoglu Y. Prognostic value of D-dimer/fibrinogen ratio on in-hospital outcomes of patients with heart failure and COVID-19. Biomark Med 2021; 15:1519-1528. [PMID: 34668382 PMCID: PMC8547277 DOI: 10.2217/bmm-2021-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: In the present study, the relationship between D-dimer/fibrinogen ratio (DFR) and in-hospital outcomes was evaluated in patients with COVID-19 and a diagnosis of heart failure (HF). Materials & methods: In-hospital outcomes were compared in patients with high and low DFR values. Results: With regard to in-hospital outcomes, patients in the third tertile of DFR had a higher rate of mechanical ventilation, cardiogenic shock and death (p < 0.001). The length of ICU stay was longer in the third tertile group (p < 0.001). When evaluated together with infection markers, DFR was found to be an independent predictor of outcomes. Conclusion: DFR can be used as a prognostic marker in patients with COVID-19 with a diagnosis of HF, and perhaps more valuable than other infection markers.
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Affiliation(s)
- Selda Murat
- Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Bektas Murat
- Department of Cardiology, Eskisehir City Hospital, Eskisehir, 26080, Turkey
| | - Muhammet Dural
- Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Gurbet Ozge Mert
- Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Yuksel Cavusoglu
- Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
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Naruse H, Ishii J, Takahashi H, Kitagawa F, Sakaguchi E, Nishimura H, Kawai H, Muramatsu T, Harada M, Yamada A, Fujiwara W, Hayashi M, Motoyama S, Sarai M, Watanabe E, Ito H, Ozaki Y, Izawa H. Combined Assessment of D-Dimer with the Get with the Guidelines-Heart Failure Risk Score and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Acute Decompensated Heart Failure with Preserved and Reduced Ejection Fraction. J Clin Med 2021; 10:jcm10163564. [PMID: 34441860 PMCID: PMC8396840 DOI: 10.3390/jcm10163564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
The prognostic role of D-dimer in different types of heart failure (HF) is poorly understood. We investigated the prognostic value of D-dimer on admission, both independently and in combination with the Get With The Guidelines—Heart Failure (GWTG-HF) risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients with preserved left ventricular ejection fraction (LVEF) and acute decompensated HF (HFpEF) or reduced LVEF (HFrEF). Baseline D-dimer levels were measured on admission in 1670 patients (mean age: 75 years) who were hospitalized for worsening HF. Of those patients, 586 (35%) were categorized as HFpEF (LVEF ≥ 50%) and 1084 as HFrEF (LVEF < 50%). During the 12-month follow-up period after admission, 360 patients died. Elevated levels (at least the highest tertile value) of D-dimer, GWTG-HF risk score, and NT-proBNP were all independently associated with mortality in all HFpEF and HFrEF patients (all p < 0.05). Adding D-dimer to a baseline model with a GWTG-HF risk score and NT-proBNP improved the net reclassification and integrated discrimination improvement for mortality greater than the baseline model alone in all populations (all p < 0.001). The number of elevations in D-dimer, GWTG-HF risk score, and NT-proBNP were independently associated with a higher risk of mortality in all study populations (HFpEF and HFrEF patients; all p < 0.001). The combination of D-dimer, which is independently predictive of mortality, with the GWTG-HF risk score and NT-proBNP could improve early prediction of 12-month mortality in patients with acute decompensated HF, regardless of the HF phenotype.
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Affiliation(s)
- Hiroyuki Naruse
- Faculty of Medical Technology, School of Health Sciences, Fujita Health University, Toyoake 470-1192, Japan
- Correspondence: ; Tel.: +81-562-93-2312; Fax: +81-562-93-2315
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Bantane Hospital, Nagoya 454-8509, Japan;
| | - Hiroshi Takahashi
- Division of Statistics, Fujita Health University School of Medicine, Toyoake 470-1192, Japan;
| | - Fumihiko Kitagawa
- Department of Cardiology, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki 444-0827, Japan; (F.K.); (E.S.); (Y.O.)
| | - Eirin Sakaguchi
- Department of Cardiology, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki 444-0827, Japan; (F.K.); (E.S.); (Y.O.)
| | - Hideto Nishimura
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Wakaya Fujiwara
- Department of Cardiology, Bantane Hospital, Nagoya 454-8509, Japan; (W.F.); (E.W.)
| | - Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
| | - Eiichi Watanabe
- Department of Cardiology, Bantane Hospital, Nagoya 454-8509, Japan; (W.F.); (E.W.)
| | - Hiroyasu Ito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan;
| | - Yukio Ozaki
- Department of Cardiology, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki 444-0827, Japan; (F.K.); (E.S.); (Y.O.)
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.N.); (H.K.); (T.M.); (M.H.); (A.Y.); (M.H.); (S.M.); (M.S.); (H.I.)
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Fibrinogen Level Predicts Outcomes in Critically Ill Patients with Acute Exacerbation of Chronic Heart Failure. DISEASE MARKERS 2021; 2021:6639393. [PMID: 34012493 PMCID: PMC8105095 DOI: 10.1155/2021/6639393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
Background Heart failure (HF) is a common cardiovascular disease, which is related to systemic inflammation for decades. Fibrinogen (FIB) is a sign of thrombosis and inflammation, which is associated with the prognosis of many diseases. Nevertheless, the role of fibrinogen level in the prognosis of critically ill patients with acute exacerbation of chronic heart failure is unclear. Methods The data are from the Medical Information Mart for Intensive Care III (MIMIC III) database, which is a freely accessible critical care database. The primary outcome in our study was 90-day mortality. The prognostic value of fibrinogen was analyzed with receiver operating characteristic (ROC) curve analysis, Kaplan-Meier curve, and Cox model. Results A total of 554 patients were included. Patients were divided into two groups, low fibrinogen level (<284 mg/dl) and high fibrinogen level (≥284 mg/dl), through the cut-off value of the ROC curve. The area under the ROC curve of fibrinogen for predicting 90-day mortality was 0.65 (95% CI: 0.59-0.70). In the unadjusted Cox model, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio (HR) with 95% confidence intervals (CI) of the high fibrinogen level is 3.33 (95% CI 2.15-5.15). In different multivariable Cox models, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio of the high fibrinogen level is from 2.83 to 3.13. In subgroup analyses, significant interactions were observed only in age, chronic kidney disease (CKD), and APS III scores. Conclusion Our data suggest that high fibrinogen levels (≥284 mg/dl) independently predict mortality in critically ill patients with acute exacerbation of chronic heart failure. Our findings need to be further validated by large prospective studies and longer follow-up time.
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