Fibrinogen is not a prognostic factor for response to HELP-apheresis in sudden sensorineural hearing loss (SSHL)

Abstract

Higher levels of fibrinogen or cholesterol were associated with improved hearing recovery in SSHL patients after treatment with HELP-apheresis (Heparin-induced extracorporeal LDL precipitation apheresis). The present trial was performed to demonstrate HELP-related effects on relevant metabolic and inflammatory parameters in the context of SSHL treatment. In the framework of a single arm non-controlled trial, we investigated the variation of metabolic and inflammatory parameters using HELP-apheresis for a defined group of 100 patients with SSHL. Based on cut off inclusion criteria (Serum LDL-cholesterol >1.6 g/l and/or fibrinogen >2.0 g/l, SSHL in minimum three frequencies more than 30 dB, time after event not longer than 6 days), the protocol followed a strict time line with one single shot HELP-apheresis and follow-up monitoring including laboratory parameters at six defined time points. If HELP-apheresis could not effect improvement of hearing on day 5, additional corticosteroid treatment was applied. Concentration of anti-inflammatory IL-10 increased while other proinflammatory parameters declined. Serum levels of all measured sterols and apolipoproteins decreased significantly. None of the investigated parameters were suitable to predict hearing improvement of the patients. Levels of fibrinogen and LDL-cholesterol were not prognostic for outcome after HELP-apheresis. A significant (p < 0.001) increase of anti-inflammatory IL-10 after apheresis was notable, while most of the proinflammatory parameters declined. Despite the limited validity of a single arm non-controlled trial, these alterations on immune modulating factors indicate possible secondary pleiotropic effects caused by HELP-apheresis.

Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography

“…The etiology of SSNHL remains unclear, and various causative factors have been proposed. 13,17,36 Patients with lowfrequency and flat-type SSNHL had larger K values and smaller angles, which indicated that they were in a relatively hypocoagulable state, as compared with those having highfrequency SSNHL and totally deafness, who were in a relatively hypercoagulable state. The reason is probably that different subgroups of SSNHL have different pathologic backgrounds.…”

“…Patients with low‐frequency and flat‐type SSNHL had larger K values and smaller angles, which indicated that they were in a relatively hypocoagulable state, as compared with those having high‐frequency SSNHL and totally deafness, who were in a relatively hypercoagulable state. The reason is probably that different subgroups of SSNHL have different pathologic backgrounds 13,17,36 . Nonetheless, all patients have normal coagulation function, so they should not be routinely treated with defibrinogenation therapy.…”

“…The reason is probably that different subgroups of SSNHL have different pathologic backgrounds. 13,17,36 Nonetheless, all patients have normal coagulation function, so they should not be routinely treated with defibrinogenation therapy.…”

“…4,[12][13][14][15][16] The state of coagulation is still controversial in SSNHL, and the relationship between changes in Fbg levels and hearing recovery has received little attention. 13,17,18 Thus, it is necessary to conduct research to confirm the coagulation status of patients with SSNHL.…”

“…Some studies suggest that Fbg levels are elevated in patients with SSNHL as compared with healthy people, while others did not find an increase in Fbg levels 4,12–16 . The state of coagulation is still controversial in SSNHL, and the relationship between changes in Fbg levels and hearing recovery has received little attention 13,17,18 . Thus, it is necessary to conduct research to confirm the coagulation status of patients with SSNHL.…”