Elevated Serum Fibrinogen Degradation Products on Admission Is a Novel Predictive Factor for Recurrence of Chronic Subdural Hematoma

Hori, Yusuke S.; Ebisudani, Yuki; Aoi, Mizuho; Fukuhara, Toru

doi:10.1016/j.wneu.2018.07.039

Cited by 9 publications

(5 citation statements)

References 40 publications

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“…This is likely due to intraoperative blood loss leading to the depletion of coagulation factors and platelets, resulting in decreased coagulation capacity 19,20 . In this study, SHG patients exhibited higher postoperative FIB levels, consistent with the ndings of Yusuke et al 21 .…”

Section: Discussionsupporting

confidence: 93%

Perioperative Hematologic Assessment for Minimizing MRI Evaluations of Iliopsoas Hematomas Following Oblique Lumbar Interbody Fusion: Risk Factor Insights from a 134-Patient Retrospective Cohort

Chen,

Song

et al. 2024

Preprint

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Background: Iliopsoas hematoma (IH) can lead to femoral nerve dysfunction and pain, typically resulting from muscle tension induced by surgery. While Oblique Lateral Lumbar Fusion (OLIF) is effective, it carries the risk of IH development. Screening for mild IH using MRI may be costly with little health benefit, but it is a reliable method for assessing Iliopsoas Hematoma-Grade (IH-G). This study seeks to establish a connection between coagulation and inflammation with the severity of IH-G following OLIF, in order to improve monitoring and management of IH. Methods: A retrospective review of 134 patients treated with OLIF from August 2019 to May 2022 was conducted. Patients were categorized into the Common Hematoma Group (CHG) with ≤50% IH-G and the Severe Hematoma Group (SHG) with >50% IH-G. The study examined the relationship between coagulation profiles, inflammation markers, and postoperative IH-G for each group. Results: Following OLIF, patients uniformly developed IH, contributing to a postoperative state characterized by anemia, hypocoagulability, and elevated inflammatory response (P<0.001). The SHG manifested significantly lower Hemoglobin (HGB) levels (P<0.05) and shorter prothrombin time (PT) (P<0.05) compared to the CHG. Additionally, the incidence of postoperative C-reactive protein (CRP) levels exceeding 8 mg/L was noticeably higher in SHG than in CHG (P<0.05). Multivariable logistic regression analysis identified Post-PT (OR=0.774, 95%CI: 0.592 to 0.9917, P<0.05) and Post-HGB (OR=0.972, 95%CI: 0.945 to 0.9966, P<0.05) as independent predictors for severe IH following OLIF. Conclusion: Post-PT and Post-HGB levels are instrumental in the early identification of serious IH risk following OLIF, facilitating prompt decision-making and intervention, thus contributing to improved prognostic outcomes. Moreover, for those at lower risk of IH, these measures can significantly reduce unnecessary MRI imaging and associated healthcare costs.

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Section: Discussionsupporting

confidence: 93%

Perioperative Hematologic Assessment for Minimizing MRI Evaluations of Iliopsoas Hematomas Following Oblique Lumbar Interbody Fusion: Risk Factor Insights from a 134-Patient Retrospective Cohort

Chen,

Song

et al. 2024

Preprint

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“…In relation to cSDH recurrence, Katano et al [23] found higher levels of TPA, a major fibrinolytic mediator, in the hematoma fluid of patients that experienced recurrences, while Wang et al [25] indicated lower levels of circulating fibrinogen in their recurrent cases. Circulating FDP (but not D-dimer) levels on patient admission as an independent predictor for recurrence was indicated by Hori et al [27]. The authors of this study hypothesized that the systemic elevation of FDP induces a systemic inflammatory response, which in turn influences expansion of the hematoma and can lead to its recurrence [27].…”

Section: Biomarkers In Recurrence Predictionmentioning

confidence: 85%

“…Circulating FDP (but not D-dimer) levels on patient admission as an independent predictor for recurrence was indicated by Hori et al [27]. The authors of this study hypothesized that the systemic elevation of FDP induces a systemic inflammatory response, which in turn influences expansion of the hematoma and can lead to its recurrence [27]. The potential of coagulation cascade mediators as peripheral biomarkers in the prediction of cSDH recurrence is further supported by studies reporting preoperative thrombocytopenia or increased PT as independent risk factors for cSDH recurrence [15,26,41] and of lower circulating factor XIII in recurrent cases [24].…”

Section: Biomarkers In Recurrence Predictionmentioning

confidence: 92%

“…A retrospective cohort study on 90 patients showed that higher preoperative PT was an independent risk factor for recurrence after surgical evacuation [26]. Another retrospective cohort study on 92 patients showed that a serum fibrinogen degradation products (FDPs) value > 5 µg/mL on admission was an independent risk factor for cSDH recurrence within 90 days [27].…”

Section: Cytokinesmentioning

confidence: 99%

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Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Georgountzos,

Gkalonakis,

Anastasopoulos

et al. 2023

Diagnostics

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The present systematic scoping review aimed at mapping and analyzing the available literature on biological fluid (biofluid) biomarkers showing promise in the prediction of chronic subdural hematoma (cSDH) recurrence and the prognosis of neurological/functional patient outcome. Twenty-three studies published between 2003 and 2023 investigating a diverse range of biomarkers in hematoma fluid and/or the circulation in 3749 patients were included. Immune cell populations and inflammatory/anti-inflammatory cytokines comprised the most studied category of biomarkers displaying significant findings. A notable time trend in biomarker studies was a recent shift in research focus towards the analysis of circulating biomarkers. Several biomarkers were indicated as independent predictors of cSDH recurrence and/or functional/neurological outcome, including circulating fibrinogen degradation products (FDP), brain natriuretic peptide (BNP-1) and high-density lipoprotein (HDL), as well as blood urea nitrogen (BUN) and the ratios of blood neutrophil to lymphocyte (NLR) or red blood cell distribution width to platelet count (RPR). While studies on cSDH prognostic biomarkers have gained, in recent years, momentum, additional multicenter prospective studies are warranted to confirm and extend their findings. The identification of prognostic biofluid biomarkers in cSDH is an active field of research that may provide future tools, guiding clinical decisions and allowing for the design of treatments based on risk stratification.

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“…Finally, fibrin clots degrade into soluble FDP by plasmin, and the significantly increased level of FDP suggests organisms in the hypercoagulative state and hyperfibrinolysis symptoms [ 29 , 30 ]. Previous studies have reported that FDP can predict neurological outcomes for patients with cardiac arrest and is associated with the recurrence of chronic subdural hematoma [ 31 , 32 ]. When aSAH occurs, the integrity of vascular endothelial cells and the blood‒brain barrier are disrupted, leading to secondary coagulation abnormalities and excessive activation of the fibrinolytic system, producing a significant amount of FDPs.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Fibrin Fibrinogen Degradation Products-to-Potassium Ratio for Poor Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case–Control Study

Li,

Zhao,

Chen

et al. 2023

Neurocrit Care

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Background The relationship of fibrin(ogen) degradation products (FDPs) and potassium with the functional outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) is still uncertain. This study aims to evaluate the predictive value of a novel combination biomarker, the FDP-to-potassium ratio (FPR), for poor functional outcomes in patients with aSAH. Methods A total of 425 consecutive patients with aSAH at a single center were retrospectively enrolled in our study. An unfavorable outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 3 months after discharge. Univariate analysis and multivariable logistic regression were performed for baseline information and laboratory parameters recorded at admission. In addition, the receiver operating characteristic curve was plotted, and propensity score matching was performed based on the FPR. Results On the basis of mRS grade, 301 patients were classified as having favorable outcomes, and 124 patients were assessed as having unfavorable outcomes. FPR levels were significantly correlated with mRS grade (r[Spearman] = 0.410; P < 0.001). Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.016–1.071; P = 0.002), white blood cell count (OR 1.150, 95% CI 1.044–1.267; P = 0.005), potassium (OR 0.526, 95% CI 0.291–0.949; P = 0.033), World Federation of Neurosurgical Societies grade (OR 1.276, 95% CI 1.055–1.544; P = 0.012), and FPR (OR 1.219, 95% CI 1.102–1.349; P < 0.001) at admission were independently associated with poor functional outcomes. The DeLong test showed that the area under the receiver operating characteristic curve of FPR was higher than that of age, white blood cell count, potassium, World Federation of Neurosurgical Societies grade, or FDP alone, indicating that FPR had better predictive potential than these other variables. After 1:1 propensity score matching (FPR ≥ 1.45 vs. FPR < 1.45), the rate of poor prognosis was still significantly increased in the high-FPR group (48/121 [39.7%] vs. 16/121 [13.2%], P < 0.001). Conclusions Fibrin(ogen) degradation product-to-potassium ratio is an independent predictor of poor outcomes for patients with aSAH and may be a promising tool for clinicians to evaluate patients’ functional prognosis.

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Elevated Serum Fibrinogen Degradation Products on Admission Is a Novel Predictive Factor for Recurrence of Chronic Subdural Hematoma

Cited by 9 publications

References 40 publications

Perioperative Hematologic Assessment for Minimizing MRI Evaluations of Iliopsoas Hematomas Following Oblique Lumbar Interbody Fusion: Risk Factor Insights from a 134-Patient Retrospective Cohort

Perioperative Hematologic Assessment for Minimizing MRI Evaluations of Iliopsoas Hematomas Following Oblique Lumbar Interbody Fusion: Risk Factor Insights from a 134-Patient Retrospective Cohort

Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

Predictive Value of Fibrin Fibrinogen Degradation Products-to-Potassium Ratio for Poor Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case–Control Study

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