Kadir Kaan OZSIN, Umut Serhat SANRI, Faruk TOKTAS, Senol YAVUZ MD

The relationship between fibrinogen to albumin ratio and carotid artery disease in patients with carotid endarterectomy and patients with non severe carotid artery stenosis

Aim: To investigate the relationship between fibrinogen to albumin ratio (FAR) and carotid artery stenosis (CAS).Material and Methods: This study included patients who underwent carotid endarterctomy (CEA) as CEA group andunoperated patients who have CAS less than 50% as non-surgical group. CAS was diagnosed with history and physicalexamination followed by doppler ultrasonography and carotid angiography. All data retrieved retrospectively from thehospital medical files. Hematologic parameters were measured and recorded. In addition, FAR was calculated.Results: Fifty patients were included in CEA group (70.0 % male, mean age: 71.0 ± 7.7 years) and 60 patients were invludedin non-surgical group (70.0 % male, mean age: 63.9 ± 8.0 years). In logistic regression analysis advanced age, presenceof coronary artery disease and FAR were identified as an independent predictor of the development of CAS. In Receiveroperating characteristic (ROC) curve analysis, for predicting development of CAS, there were 68.0% sensitivity and 65.0%specificity for FAR (area under the curve [AUC]: 0.669, 95% CI: 0.566-0.771, log rank p = 0.002).Conclusion: We found that FAR were identified as an independent predictor of the development of CAS. FAR could be apotential marker on carotid atherosclerosis in patients. But there is a need large studies including all cardiovascular diseases.

Karotis endarterektomili ve şiddetli olmayan karotis arter darlığı olan hastalarda fibrinojen / albümin oranı ve karotis arter hastalığı arasındaki ilişki

Amaç: Fibrinojen ile albumin oranı (FAR) ve karotis arter stenozu (KAS) arasındaki ilişkiyi araştırmak. Gereç ve Yöntemler: Bu çalışma, karotis endarterektomisi (KEA) geçiren hastaları ve % 50'den az karotis arter stenozu olan hastaları içermektedir. KAS tanısı fizik muayene, tıbbi hikaye ve ardından doppler ultrasonografi ve karotis anjiyografi ile konuldu. Tüm veriler hastane tıbbi dosyalarından retrospektif olarak alındı. Laboratuvar kan sonuçları ve kaydedildi ve FAR hesaplandı. Bulgular: Elli hasta KEA grubuna dahil edildi (% 70 erkek, ortalama yaş: 71.0 ± 7.7 ) ve 60 hasta cerrahi olmayan grubuna dahil edildi (% 70 erkek, ortalama yaş: 63.9 ± 8.0 ). Lojistik regresyon analizinde ileri yaş, koroner arter hastalığı ve FAR varlığı KAS gelişiminin bağımsız bir prediktörü olarak tanımlandı. Receiver operating characteristic (ROC) eğrisisi analizinde, KAS gelişimini tahmin etmek için FAR için % 68.0 duyarlılık ve % 65.0 özgüllük vardı (Area Under the Curve [AUC]: 0.669, 95% CI: 0.566-0.771, log rank p = 0.002). Sonuçlar: FAR'ın KAS gelişiminin bağımsız bir öngörücüsü olarak tanımlandığını bulduk. FAR, hastalarda karotis aterosklerozu üzerinde potansiyel bir belirteç olabilir. Ancak, tüm kardiyovasküler hastalıkları içeren büyük çalışmalara ihtiyaç vardır.

PDF

___

1. Boulos NM, Gardin JM, Malik S, Postley J, Wong ND. Carotid plaque characterization, stenosis, and intima-media thickness according to age and gender in a large registry cohort. Am J Cardio 2016; 117: 1185-91.

2. Divya KP, Sandeep N, Sarma S, Sylaja PN. Risk of stroke and cardiac events in medically treated asymptomatic carotid stenosis. J Stroke Cerebrovasc Dis 2015; 24: 2149-53.

3. Gresele P, Deckmyn H, Huybrechts E, Vermylen J. Serum albumin enhances the impairment of platelet aggregation with thromboxane synthase inhibition by increasing the formation of prostaglandin D2. Biochem Pharmaco. 1984; 33: 2083-88.

4. Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine. Kidney Int 1997; 52: 761-70.

5. Oduncu V, Erkol A, Karabay CY et al. The prognostic value of serum albumin levels on admission in patients with acute STsegment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis 2013; 24: 88-94.

6. Pieters M, Kotze RC, Jerling JC, Kruger A, Ariëns RAS. Evidence that fibrinogen ý regulates plasma clot structure and lysis and relationship to cardiovascular risk factors in black Africans. Blood 2013; 121: 3254-60.

7. Batagini1 NC, Silva ES, Pinto CAV, Puech-Leăo P, Luccia N. Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis. Vascular 2015; 24: 59-63

8. Perl ML, Finkelstein A, Revivo M et al. Variance in Biomarker Usefulness as Indicators for Carotid and Coronary Atherosclerosis. IMAJ 2016; 18: 80–84.

9. Zhang Y, Zhu CG, Guo YL et al. Higher fibrinogen level is independently linked with the presence and severity of newonset coronary atherosclerosis among Han Chinese population. PLoS One 2014; 9: 113460.

10. Van den Munckhof ICL, Jones H, Hopman MTE et al. Relation between age and carotid artery intima-medial thickness: a systematic review. Clin Cardiol 2018; 41: 698-704.

11. Yokokawa H, Yasumura S, Tanno K et al. Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7- year cohort study of a Japanese northern rural population. J Atheroscler Thromb 2011; 18: 89-98.

12. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002; 106: 3143-421

13. Folsom AR, Wu KK, Rosamond WD, Sharrett AR, Chambless LE. Prospective study of hemostatic factors and incidence of coronary heart disease: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 1997; 96: 1102-8.

14. Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L,Tibblin G. Fibrinogen as risk factor for stroke and myocardial infarction.N Eng J Med 1984; 311: 501-5.

15. Cho HM, Kang DR, Kim HC, Oh SM, Kim BK, Il Suh. Association between Fibrinogen and Carotid Atherosclerosis According to Smoking Status in a Korean Male Population. Yonsei Med J 2015; 56: 921-927.

16. Ishihara KK, Kokubo Y, Yokota C et al. Effect of Plasma Fibrinogen, High-Sensitive C-Reactive Protein, and Cigarette Smoking on Carotid Atherosclerosis: The Suita Study. Journal of Stroke and Cerebrovascular Diseases. J Stroke Cerebrovasc Dis. 2015; 24: 2385-89 325 Volume9 Number 4 p: 321-326

17. Xu O, Yan Y, Gu S et al. A Novel Inflammation-Based Prognostic Score: The Fibrinogen/Albumin Ratio Predicts Prognoses of Patients after Curative Resection for Hepatocellular Carcinoma. Journal of Immunology Research 2018; 1-11

18. Seo MH, Choa M, You JS, et al. “Hypoalbuminemia, low base excess values, and tachypnea predict 28-day mortality in severe sepsis and septic shock patients in the emergency department,” Yonsei Medical Journal 2016: 57; 1361–69.

19. Hwang KT, Chung JK, Roh EY, et al. Prognostic Influence of Preoperative Fibrinogen to Albumin Ratio for Breast Cancer. J Breast Cancer 2017; 20: 254-63.

20. Li XH, Gu WS, Wang XP et al. Low Preoperative albumin-toglobulin ratio Predict Poor Survival and Negatively Correlated with Fibrinogen in Resectable Esophageal Squamous Cell Carcinoma. Journal of Cancer 2017; 8: 1833-42.

21. Li SQ, Jiang YH, Lin J et al. Albumin-to- Fibrinogen ratio as a promising biomarker to predict clinical outcome of non-small cell lung cancer individuals. Cancer Medicine 2018; 7: 1221–31.

22. Karahan O, Acet H, Ertaş F et al. The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI. Am J Emerg Med. 2016; 34: 1037-42.