Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke – Evidence From the Indian Population

Abstract

Background Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen – a key component of the coagulation pathway, is controversial. Objective To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke. Design Single-centre prospective observational study. Methods 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome. Results Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P = .038). Conclusion The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.

Nonlinear association of fibrinogen levels with functional prognosis in patients with acute ischemic stroke: a prospective cohort study

“…A study using data from China’s National Stroke Registry III, which included 10,518 patients with AIS within seven days of onset (baseline), showed that high baseline fibrinogen levels were associated with poor functional prognosis (mRs > 2) (OR = 1.63; 95%=CI:1.35–1.97) [ 41 ]. Similar results were obtained in a small-sample study from India, where baseline fibrinogen (per 1 mg/dL) was positively associated with poor functional prognosis (OR = 1.011, 95% CI 1.006–1.015, P < 0.001) [ 18 ]. However, some studies have yielded inconsistent results.…”

“…One study confirmed that hyperfibrinogenemia (> 4.0 g/L) is associated with a 1.76-fold increase in the risk of in-hospital mortality (hazard ratio, HR = 1.76; 95% confidence interval [CI]: 1.10–2.81), but found no significant association with poor prognosis at discharge (mRS > 3) [ 17 ]. A study from India demonstrated through regression analysis that fibrinogen levels (mg/dl) were positively correlated with early neurological deterioration (OR = 1.004, 95% CI 1.000-1.007, P = 0.038) [ 18 ]. Another study showed that after adjusting for potential confounders, the relationship between fibrinogen levels and poor outcomes after AIS (mRS > 3) was not significant (OR = 1.05, 95% CI: 0.90–1.21) [ 19 ].…”

Evaluation of routine laboratory markers as short-term outcome indicators in patients with acute ischemic stroke

“…Conversely, elevated fibrinogen levels serve as an autonomous risk factor for both venous and arterial clotting, correlating with a more intense progression and poorer prognosis [27][28][29][30]. According to some authors, hyperfibrinogenemia is positively correlated with the type of infarction and the presence of ischemic lesions in the CT findings of cerebral ischemia [29,30].…”

“…Conversely, elevated fibrinogen levels serve as an autonomous risk factor for both venous and arterial clotting, correlating with a more intense progression and poorer prognosis [27][28][29][30]. According to some authors, hyperfibrinogenemia is positively correlated with the type of infarction and the presence of ischemic lesions in the CT findings of cerebral ischemia [29,30]. Peycheva et al [31] discovered that individuals with atherothrombotic stroke exhibited higher average fibrinogen levels (>4.0 g/l) in comparison to those with different stroke subtypes.…”

Evaluation of the Selected Parameters of Inflammation in Patients with Haemorrhagic Stroke

“…There was no significant relationship between fibrinogen levels and neurological deficit. In turn, Mehta et al [16] showed that the National Institutes of Health Stroke Scale score at admission (Odds Ratio (OR) 1.152 [95% CI 1.070-1.240], p<0.001), age (OR) 1.034 [95% CI 1.001- An increase in the level of fibrinogen is associated with an increased risk of ischemic stroke, and according to recent reports -also haemorrhagic. Sturgeon et al [14] prove that high levels of fibrinogen increase the risk of CNS bleeding.…”