Elevated fibrinogen and fibrin degradation product are associated with poor outcome in COVID-19 patients: A meta-analysis

Abstract

INTRODUCTION: COVID-19 is a systemic infection with a significant impact on coagulation which manifests in thromboembolism. There is an unknown relationship of which coagulation profile parameter at presentation has an association with poor outcome in COVID-19. OBJECTIVE: This meta-analysis aimed to determine the relationship between fibrinogen and FDP with poor outcome in COVID-19 patients. METHODS: A systematic search of all observational studies or trials involving adult patients with COVID-19 that had any data fibrinogen or FDP on admission was carried out using the PubMed, Science Direct, Scopus, ProQuest, and MedRxiv databases. We assessed the methodological quality assessment using the NIH Quality Assessment Tool. We performed random-effects inverse-variance weighting analysis using mean difference (MD). RESULTS: A total of 17 studies (1,654 patients) were included in this meta-analysis. It revealed a higher mean of fibrinogen levels on admission in patients with severe case compared to those with non-severe case (MD = 0.69, [95% CI: 0.44 to 0.94], p < 0.05; I2 = 72%, p < 0.05). Non-survivor group had a pooled higher mean difference of fibrinogen values on admission (MD = 0.48 [95% CI: 0.13 to 0.83], p < 0.05; I2 = 38%, p = 0.18). Higher FDP on admission was found in poor outcome (composite of severity, critically ill, and mortality) compared to good outcome (4 studies, MD = 4.84 [95% CI: 0.75 to 8.93], p < 0.05; I2 = 86%, p < 0.05). CONCLUSION: Elevated fibrinogen and FDP level on admission were associated with an increase risk of poor outcome in COVID-19 patients.

COVID‐19 and venous thromboembolism: A narrative review

“…Specifically, elevations in fibrinogen, fibrinogen degradation product, C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and D-dimer have been found to be associated with increased severity of disease. [16][17][18] Severe thrombocytopenia and lymphopenia have also been associated with poorer outcomes, both independently and in the setting of disseminated intravascular coagulation (DIC). 19,20 Obtaining these clinical parameters may provide further information for the prediction of VTE (as discussed below) as well as overall prognosis.…”

“…Hematologic and inflammatory laboratory abnormalities have been found to correlate with disease severity in patients with COVID‐19. Specifically, elevations in fibrinogen, fibrinogen degradation product, C‐reactive protein (CRP), interleukin‐6 (IL‐6), erythrocyte sedimentation rate (ESR), and D‐dimer have been found to be associated with increased severity of disease 16‐18 . Severe thrombocytopenia and lymphopenia have also been associated with poorer outcomes, both independently and in the setting of disseminated intravascular coagulation (DIC) 19,20 .…”

Development and Validation of a Predictive Nomogram with Age and Laboratory Findings for Severe COVID-19 in Hunan Province, China

“… 56 In the current study, we found that high level of fibrinogen at admission significantly increased the risk of developing severe COVID-19. The results from a meta-analysis showed that the mean fibrinogen value at admission was significantly higher in patients with severe COVID-19 than in those with non-severe disease, 57 which suggests that high fibrinogen level can also serve as a marker of poor prognosis in patients with COVID-19.…”

The Screening of Fixation‐Related Infection in Patients Undergoing Conversion Total Hip Arthroplasty after Failed Internal Fixation of Hip Fractures: A Single‐Central Retrospective Study

“…The Roles of Fibrinogen in Inflammation and Infection Appropriate levels of fibrinogen, a glycol protein secreted from the liver, are required for hemostasis and homeostasis 23 , and levels can reflect injury, inflammation and infection [24][25][26] . In pediatric sepsis, fibrinogen levels lower than 2 g/L are strongly associated with higher risk of death 27 , while in COVID-19 patients, elevated fibrinogen level is associated with higher risk of a poor outcome 28 . Previous studies have suggested that fibrinogen has potential for diagnosing PJI before revision hip and knee arthroplasty 17,29,30 .…”