In the nationally representative NHANES III data, impaired lung function is a correlate of fibrinogen levels and the presence of higher fibrinogen levels increases the risk of mortality both in the overall population and among subjects with COPD.
BackgroundFibrinogen is a marker of systemic inflammation and may be important in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD).MethodsWe used baseline data from Atherosclerosis Risk in Communities and Cardiovascular Health Studies to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected outcomes of death, development of COPD, lung function decline, and COPD-hospitalizations.ResultsOur study sample included 20,192 subjects, of whom 2995 died during the follow-up period. The mean fibrinogen level was 307.6 mg/dL and 10% of the sample had levels >393.0 mg/dL. Subjects with Stage 3 or 4 COPD were more likely to have a fibrinogen level >393.0 mg/dL (odds ratio 2.28, 95% confidence interval [CI]: 1.79–2.95). In the longitudinal adjusted models, fibrinogen levels >393 mg/dL predicted mortality (hazards ratio 1.54, 95% CI: 1.39–1.70), COPD-related hospitalization (hazards ratio 1.45, 95% CI: 1.27–1.67), and incident Stage 2 COPD (odds ratio 1.36, 95% CI: 1.07–1.74). Similar findings were seen with continuous fibrinogen levels.ConclusionIn the Atherosclerosis Risk in Communities/Cardiovascular Health Studies cohort data, higher fibrinogen levels are predictors of mortality, COPD-related hospitalizations, and incident Stage 2 COPD.
The combination of rising rates of obesity and the shortage of deceased donor livers have forced the consideration of marginal liver donors in terms of body mass index (BMI) for liver transplantation (LT). To date, there are still conflicting data on the impact of donor obesity on post‐LT outcomes. We analyzed all patients undergoing LT alone in the United States (US) from October 2005 through December 2019 using the United Network of Organ Sharing (UNOS) data set. We categorized donor BMI >40 kg/m2 as extremely obese (EO). Primary endpoints included 30‐day perioperative mortality and early graft loss (EGL) within 7 days. A subgroup analysis was performed for the EO donor group to assess how macrovesicular steatosis (MaS) >30% affects 30‐day mortality and EGL within 7 days. A total of 72,616 patients underwent LT during the study period. The 30‐day perioperative mortality was significantly higher in the EO donor group (P = 0.02). On multivariate analysis, recipients undergoing LT with EO donors had a 38% higher 30‐day mortality risk (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.21‐1.69) and 53% increased risk of EGL (OR, 1.53; 95% CI, 1.22‐1.90). MaS >30% was independently associated with a 2‐fold increased risk of 30‐day mortality (P = 0.003) and 3.5‐fold increased risk of EGL within 7 days (P < 0.001). The impact of MaS >30% in EGL was 2‐fold for all patients transplanted during the study period compared with 3.5‐fold in the EO donor group. There is an increased risk of EGL and 30‐day perioperative mortality in recipients transplanted with EO donors. Future studies are warranted in morbid and super obese donors to assess the possible effect of obesity‐related proinflammatory factors in EGL.
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