Elevated Plasma Fibrinogen and the Risk of Stroke: A Hospital Based Prospective Case-Control Study in Uyo, Nigeria

Background: Stroke is one of the leading causes of morbidity and mortality globally. In recent time, there is increasing evidence that suggest that increased plasma fibrinogen is associated with increased risk of stroke with unfavourable clinical outcome. Objectives: To determine the plasma fibrinogen levels in stroke patients and compare with healthy controls. Study Design: The study design was Prospective case- control study. Place and Duration of Study: The study was conducted in the department of Internal Medicine (Neurology Unit) and the department of Haematology between March to August, 2019. Methodology: A case- control study consisting of 41 patients (21M: 19F) diagnosed with stroke in line with WHO definition and confirmed by CT-Scan of the brain were recruited consecutively into the study. 20 (10M: 10F) healthy age and gender matched consenting adults were used as controls. Plasma fibrinogen was determined for both the patients and controls using ELISA method. Also, socio-demographic and clinical data were collected using questionnaire designed for the study. The level of significance was set at P=.05. Results: The mean plasma fibrinogen level of 458.0 ± 89.1 was significantly higher in the stroke patients compared to the controls 307.8 ± 61.5 (P<0.001). An increasing level of plasma fibrinogen was observed with increasing age in both the patients and controls. However, this increase was not statistically significant (P=0.98). Also, the plasma fibrinogen level was significantly higher in the female patients (501.21±83.96) than the males 420.59±77.02 (P=0.003). Conclusion: Plasma fibrinogen was significantly higher in the stroke patients compared to the controls with female patients having a significantly higher levels than males. Also, the plasma fibrinogen levels appear to increase proportionally with increasing age.

Periprocedural Plasma Fibrinogen level and Clinical Outcome of Coronary Stent Implantation

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. Percutaneous recanalization of occluded coronary artery is one of the treatment options and reinfarction and restenosis negatively affect the outcome following procedure. Although various factors including fibrinogen are suspected as risk factors for this but its role in adverse outcome after stent implantation is controversial. The aim of this study was to determine the impact & relation of periprocedural fibrinogen level on outcome after coronary stent implantation. This prospective study was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Hospital, Dhaka over a period of one year between July 2016 to June 2017. Total 53 patients of chronic stable angina (CSA) undergoing elective PTCA followed by stenting were included in this study as per inclusion and exclusion criteria. Plasma fibrinogen level was measured by collecting venous blood samples at three timed points in relation to stenting – 24 h before, 24 h after and 72 h after stenting. Recurrence of angina, myocardial infarction, repeat revascularization (either PCI or Cardiac surgery), and death were considered as adverse outcome during follow up at 1, 3 and 6 months after intervention. During the 6 months follow up period 1 (one) patient developed UA (at 1 month), 2 developed MI (1 at 3 month and 1 at 6 month) and 2 died (1 at 3 month and 1 at 6 month). Patients were grouped on the basis of four outcomes: favorable outcome (those who did not develop any of the four outcomes) and unfavorable or adverse outcome (those who developed any of the four outcomes). The mean age of study population was 53.92 years and 39 (73.6%) were male. Regarding cardiovascular risk factors, 43.4% patients had diabetes mellitus, 88.6% had dyslipidaemia, 56.6% were non-smokers. Baseline plasma fibrinogen level were significantly higher in patients who developed complications following PCI than those who did not develop the complications (394.4 ± 16.0 Vs 271.5 ± 21.8 mg/dl) & remained high after 24 hours and 72 hours following PCI (p < 0.001). Angiographic profiles of the study population reveals 84.9% LAD, 16.9% RCA & 15% LCX involvement but there was no association of post-PCI adverse outcomes with vessels involved, number of stents deployed and types of stents used (p > 0.05). Study showed that the risk of developing unfavorable outcome following PCI in patients with pre-PCI & post-PCI high serum fibrinogen was estimated to be 5.7 times & 12 times higher than those who have had serum fibrinogen lower than 350 mg/ dl respectively (p = 0.023 & 0.025 respectively). High serum fibrinogen can therefore be used as a marker for predicting adverse outcome following PCI. University Heart Journal Vol. 17, No. 2, Jul 2021; 122-127

Plasma Fibrinogen as a Biomarker of Stable and Exacerbated Chronic Obstructive Pulmonary Disease

Study Design: An experimental, comparative, cross-sectional study Place and Duration of Study: Department of Physiology, Federal Post Graduate Medical Institute (FPGMI), Sheikh Zayed Medical Complex Lahore, Pakistan from August 2013 to 2014 Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease, but is a partially reversible chronic inflammatory condition characterized by airway obstruction. COPD remains under-diagnosed and under-treated because the only available diagnostic method at present is testing lung functions by spirometry which is not helpful to determine the severity and clinical outcomes of the disease. Circulating biomarkers are under consideration for various diseases worldwide. Plasma fibrinogen is emerging as one of the most promising biomarkers of COPD in smokers. Objective: The objective of this study is to investigate if plasma fibrinogen can serve as a diagnostic biomarker of COPD in smokers, and if its further higher levels are seen in the exacerbated state of the disease in comparison to the stable disease. Materials and Methods: 75 middle-aged to old-age smokers of either gender were selected. Lung functions of every participant were measured to determine Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), and the ratio of FEV1/FVC by spirometry. On the basis of the results of the tests, subjects were divided into three groups; firstly, the control group of chronic smokers without COPD, secondly, smokers with COPD in a stable state, and thirdly, patients in an exacerbated state of COPD. Plasma fibrinogen was quantitatively estimated in every individual of all three groups by the Clauss method using the Hemostat Fibrinogen kit. Results: The average Plasma fibrinogen level was found to be 235.008 mg/dl in healthy smokers (control group), while an average of 440.12mg/dl was measured in patients with stable COPD. The difference in plasma fibrinogen levels was found to be significant, having a p-value of (0.000). In the third group with declined lung function predicting acute exacerbated COPD, fibrinogen was found to be > 453.2 mg/dl, which was significantly higher than in the stable disease group (p-value > 0.0017) Conclusion: Plasma fibrinogen level measurement is a reliable and accessible test in terms of a diagnostic marker of COPD, as compared to conventional lung function testing done in the past.

Plasma Fibrinogen Level in Chronic Obstructive Pulmonary Disease and Its Correlation with GOLD Severity Staging

Introduction Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction. MethodsThis observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done. ResultA total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p<0.001). There was significant negative correlation between plasma fibrinogen level and forced expiratory volume in one second (FEV1%) predicted (r=-0.71, p=0.01). ConclusionHigh plasma fibrinogen level on discharge was found in COPD patients with severe airflow obstruction, frequent exacerbations and severe level of dyspnoea during AECOPD.

Measurement of plasma fibrinogen and D-dimer in a sample of Iraqi patients with solid malignant tumors

Background: Multifactor affect the pathogenesis of thrombosis in solid malignancy; however, a significant role is attributed to the cancer cells ability to interact with and activate the host hemostatic system. [1] Hemostasis is highly correlated to tumor growth, angiogenesis and metastasis, modulation of these pathways reflects interesting and promising treatment options in the future. [1] Most patients with cancer frequently suffer from chronic compensated DIC and have abnormal laboratory coagulation tests without clinical manifestations of thrombosis, which is a subclinical hypercoagulable state that can be detected by varying degrees of activation of blood clotting. The results of laboratory tests in these patients reflect continuous fibrin formation and lysis during the course of malignancy. [1] Aim of study: To study the effect of solid malignant tumors on blood coagulation via measurements of plasma fibrinogen and D-dimer. Subjects and methods: Thirty patients (9 males and 21 females) attending the oncology consultatory out-patient clinic at Baghdad Teaching Hospital/ Medical City were randomly selected and included in this study. These patients were newly diagnosed as having malignant solid tumors depending on histopathological reports from private and governmental sectors. All the laboratory tests were done at the hematology and biochemistry departments of Teaching Laboratories/ Medical City. Results: Plasma fibrinogen level was significantly higher in patients group rather than control group (3.863 ±0.706) Vs (2.497±0.457 g/L} respectively, (P-value 0.001).The mean value of factor VIII activity was {181% ±58.4)and (99.3% ±11.1)for patient and control groups respectively, the P-Value was significant ( > 0.001 ).D-dimer was negative for all members of control group, for patients group ( 66.7 %) of them showed positive D-dimer and (33.3)were negative for D-dimer ,P-value was significant ( >0.001 ). Conclusions: There was increase in plasma fibrinogen level and positive D-dimer in cancer patients compared to the control group reflecting subclinical thrombophilia and higher risk of VTE in patients with solid tumors due to activation of prothrombotic and fibrinolytic pathways by malignant cells which is vital for the use of primary prophylaxis by anticoagulants.

Preoperative Plasma Fibrinogen Level: An Independent Predictor for Survival in Adult Patients With Xp11.2 Translocation Renal Cell Carcinoma

BackgroundXp11.2 translocation renal cell carcinoma (Xp11.2 RCC) is a rare malignancy which is more common in children than in adults. It manifests with an aggressive course in adults and relatively indolent in children. Prognostic studies for adult patients are scare for the rarity of the disease; and the prognostic value of preoperative plasma fibrinogen level awaits further illumination.MethodsThis retrospective single-center study enrolled 24 consecutive newly diagnosed Xp11.2 RCC adult patients. Clinical presentations, baseline laboratory results and follow-up data were collected. Possible risk factors for progression free survival (PFS) and overall survival (OS) were first scanned with chi-square tests and t-tests to compare patients who suffered from progression or death and who did not. Independent risk factors for survival were further investigated with multivariate Cox regression.ResultsTwenty-four adult patients (median age 32, range 16-73), with a male-to-female ratio of 12:12, was included from 2010.4 to 2020.3. After a mean follow-up of 35.7months, seven patients died. With univariate analysis, higher C-reactive protein-to-albumin ratio (p=0.028), higher baseline fibrinogen level (p=0.006), and presence of distant metastasis(p=0.007) were associated with progression of disease; higher preoperative fibrinogen level (p=0.014) and distant metastasis (p= 0.020) were associated with death. With multivariate Cox regression, only baseline fibrinogen level (p=0.001) was identified as an independent risk factor for progression free survival; meanwhile, fibrinogen level (p= 0.048) and distant metastasis (p= 0.043) were identified as independent risk factors for survival.ConclusionsPreoperative plasma fibrinogen level, a routinely tested parameter before surgery, is a promising tool for risk stratification in adult patients with Xp11.2 RCC.

A study of correlation of plasma fibrinogen levels with glycemic status in type 2 Diabetes Mellitus patients

Background: Plasma fibrinogen is an indicator of inflammation and endothelial dysfunction has been described as an independent risk factor for cardiovascular morbidity in type 2 Diabetes mellitus patients. Poor glycemic control has been reported to be associated with hyperfibrinogenemia and its complications. This study was aimed to find a correlation of mean fibrinogen level with glycemic control in complicated and uncomplicated cases of Type 2 Diabetes mellitus. Materials and methods: One hundred eight known cases of Type 2 Diabetes mellitus aged ≥ 30 were included in our study of which 39 cases were uncomplicated and 69 cases were complicated Diabetes mellitus. Hundred of non-diabetic age and sex-matched controls were analyzed. Blood samples were collected in Ethylenediaminetetraacetic acid and citrate bulb for estimation of HbA1c and plasma fibrinogen level respectively. Results: Mean fibrinogen level in complicated Type 2 Diabetes mellitus was high 450.43 ±108.51 mg/dl as compared to uncomplicated cases 372.30±123.78 mg/dl (p=0.0001). Mean HbA1c in total Diabetes mellitus cases was 8.02±1.88 mg/dl with a range of 5.50-14.50 mg/dl. A positive correlation was found between HbA1c and mean fibrinogen level (r=0.782, p= 0.001) in type 2 Diabetes mellitus. Duration of diabetes in years showed a significant correlation with mean fibrinogen levels (r=0.295, p=0.002). Conclusions: Plasma fibrinogen level was significantly associated with glycemic control (HbA1c) and duration of Diabetes mellitus in years. Thus, lowering plasma fibrinogen levels could be an important approach to the prevention of cardiovascular complications in diabetics.

Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients

Background: Bleeding is a major concern after cardiac surgery and also a significant cause of morbidity and mortality. Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: To find out Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients. Methods: This comparative cross-sectional study was carried out at the Department of Cardiac Surgery in BSMMU hospital from March, 2017 to August, 2019. The study population was 60, with 2 (two) groups having 30 patients in each. Patients from both the groups underwent OPCAB. Statistical analysis of different characteristics between the patients of both groups was done to draw a conclusion. Results: This study total sixty (60) patients who underwent off-pump coronary artery bypass graft surgery were evaluated in this study. Postoperative care at ICU was given to the patients of both groups as per standard hospital protocol. The findings of the study obtained from data analysis presented in the following pages. Among the study population mean age in group A was 55.43±8.53 years and in group B was 59.63±6.86 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were statistically not significant (p>0.05). Shows the comparison of postoperative variables between group A and B patients. Amount blood loss in 1st 12 hours immediate after surgery in group A and B were 185.67±35.20 ml and 219.67±57.32 ml respectively. Post-operative blood transfusion in group A and B were 2±0.53 units and 2.5±0.68 units respectively, which was statistically significant (p<0.05. There were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. The most valuable predictor for increased postoperative bleeding after OPCAB. Conclusion: In conclusion the efficacy were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. Pearson co-efficient correlation test showed an inverse relationship between plasma fibrinogen level and postoperative bleeding following OPCAB. Fibrinogen concentration level was associated with increased postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting surgical patients.

Preoperative plasma fibrinogen level and transfusion in cardiac surgery: a biphasic correlation

Coagulopathic bleeding is a serious complication of cardiac surgery. A very low preoperative plasma fibrinogen level (PFL) has been previously described as a risk factor for red blood cell (RBC) transfusion in the perioperative setting. Nevertheless, contradictory results have been published concerning preoperative fibrinogen infusion to decrease RBC transfusion. These results highlight the need for a better description of the relation between preoperative PFL and RBC transfusion. In this single-centre retrospective study, we showed that both high and low PFLs are associated with an increase in RBC transfusion. A pro-inflammatory preoperative status could be involved in the association between high PFL and the increase in RBC transfusion. This non-linear relation between PFL and RBC transfusion could explain the difficulty of decreasing postoperative bleeding using only an algorithm aimed at increasing preoperative PFL.