Fibrinogen–Albumin-Ratio is an independent predictor of thromboembolic complications in patients undergoing VA-ECMO

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients suffering from refractory cardiogenic shock. Thromboembolic complications (TeC) are common in VA-ECMO patients and are associated with increased morbidity and mortality. Valid markers to predict TeC in VA-ECMO patients are lacking. The present study investigated the predictive value of baseline Fibrinogen–Albumin-Ratio (FAR) for in-hospital TeC in patients undergoing VA-ECMO. This retrospective cohort study included patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany between 2011 and 2018. Main exposure was baseline FAR measured at initiation of VA-ECMO therapy. The primary endpoint was the in-hospital incidence of TeC. In total, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. Receiver operating characteristics (ROC) curve of FAR for in-hospital TeC revealed an area under the curve of 0.67 [95% confidence interval (CI) 0.61–0.74]. Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds-ratio of 3.72 [95% CI 2.26–6.14] for the association between FAR and TeC. Baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, FAR might contribute to the prediction of TeC in this cohort.

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

“…Finally, a high fibrinogen level (≥ 6 g/L) was associated with greater odds of thrombosis. Elevated fibrinogen levels have been associated with thrombosis risk in the general population [59,60] but the evidence in ECMO patients remains scarce [61].…”

Fibrinogen and Atherosclerotic Cardiovascular Diseases—Review of the Literature and Clinical Studies

“…Importantly, the high clinical usefulness of the FAR assessment was also demonstrated in the study by Roth et al, which included 344 patients with cardiogenic shock refractory who underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO). It was shown that a higher FAR was significantly associated with the risk of in-hospital thromboembolic complications (OR = 3.72; 95% CI: 2.26–6.14) [ 56 ]. The FAR assessment may also be useful in assessing the severity of CAD.…”

Low albumin‐to‐fibrinogen ratio predicts adverse clinical outcomes after primary total joint arthroplasty: A retrospective observational investigation

“…13,14,22 Emerging publications showed that AFR is, in fact, superior to albumin in reflecting nutritional status, and in predicting postoperative patient prognosis. 15,23 For instance, a recent study by Fang et al demonstrated that AFR possesses strong prognostic capability, and accurately predicts the overall survival of patients with pancreatic cancer. 13 Likewise, Seoyeong and colleagues reported that the preoperative FAR is a prognostic biomarker for mortality after off-pump coronary artery bypass grafting, and an elevated FAR (reduced AFR) value is intricately linked to an enhanced postoperative all-cause mortality risk.…”

“…Being a readily measured biomarker of nutritional status, AFR was previously proposed to correlate with the clinical outcomes of a variety of human diseases 13,14,22 . Emerging publications showed that AFR is, in fact, superior to albumin in reflecting nutritional status, and in predicting postoperative patient prognosis 15,23 . For instance, a recent study by Fang et al demonstrated that AFR possesses strong prognostic capability, and accurately predicts the overall survival of patients with pancreatic cancer 13 .…”