Abstract
Amaç: Böbrek yetmezliği, özellikle son dönem böbrek hastalığında, çeşitli faktörlere bağlı akut ve kronik enflamatuvar süreçlerle ilişkilidir. Fibrinojen albümin oranı (FAR) çeşitli hastalıklarda enflamatuvar bir belirteç olarak umut vaat etmektedir, ancak yoğun bakım diyaliz hastalarında prognostik değeri belirsizliğini korumaktadır. Bu çalışmanın amacı, bu spesifik hasta popülasyonunda mortalite için potansiyel bir prognostik indeks olarak FAR’yi araştırmaktır.
Gereç ve Yöntem: Dahiliye ve anestezi yoğun bakım ünitelerine 12.12.2021 ile 15.12.2023 tarihleri arasında diyalize giren 226 hastanın retrospektif analizi yapıldı. Dahil edilme kriterleri yaş ≥18, albümin veya böbrek hastalığı tanısı ve tam klinik ve laboratuvar verilerinin mevcut olmasıydı. Dışlama kriterleri arasında böbrek hastalığı ile ilişkili olmayan anemi ve ilgili verilere erişememe yer aldı. Demografik, klinik ve laboratuvar değişkenleri toplandı ve istatistiksel analizler yapıldı.
Bulgular: Çalışmada mortalite ile düşük vücut kitle indeksi, yüksek APACHE II skorları, yüksek kreatinin seviyeleri, düşük glomerüler filtrasyon hızı, yüksek albümin seviyeleri ve artmış FAR arasında anlamlı ilişkiler tespit edilmiştir. Mortalite için FAR kesme noktası %81,75 duyarlılık, %39 özgüllük%62,80 pozitif prediktif değer ve %62,90 negatif prediktif değer ile 241 olarak belirlenmiştir. ROC analizine göre eğri altındaki alan %58,1 bulundu.
Sonuç: FAR, yoğun bakım diyaliz hastalarında mortalite için prognostik bir gösterge olarak umut vaat etmektedir. Klinik kullanılabilirliğini doğrulamak için daha ileri prospektif ve çok merkezli çalışmalara ihtiyaç duyulsa da, FAR bu spesifik popülasyonda gelişmiş prognostik değerlendirmelere ve iyileştirilmiş hasta bakımına katkıda bulunabilir.
Anahtar Kelimeler: Fibrinojen albümin oranı, mortalite, akut böbrek hasarı, kronik böbrek hastalığı
Ethical Statement
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Project Number
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References
- 1. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002;15:329-337.
- 2. Tai H, Zhu Z, Mei H, et al. Albumin-to-Fibrinogen Ratio Independently Predicts 28-Day Mortality in Patients with Peritonitis-Induced Sepsis. Mediators Inflamm. 2020;2020:7280708.
- 3. Xiao, L, Jia, Y, Wang X, et al. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clinica Chimica Acta. 2019;493:8-13.
- 4. Gao K, Zhang Y, Sun S, et al. Novel inflammatory markers in the blood of patients with knee synovitis. J Int Med Res. 2021;49:3000605211029557.
- 5. You X, Zhou Q, Song J, et al. (2019). Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy. BMC Cancer. 2019;19:931.
- 6. Ruan Y, Yuan C, Liu Y, et al. High fibrinogen-to-albumin ratio is associated with hemorrhagic transformation in acute ischemic stroke patients. Brain Behav. 2021;11:e01855.
- 7. Xia W, Li C, Yao X, et al. Prognostic value of fibrinogen to albumin ratios among critically ill patients with acute kidney injury. Intern Emerg Med. 2022;17:1023-1031.
- 8. Zou Y, Zhu Z, Zhou J, et al. Fibrinogen/Albumin ratio: A more powerful prognostic index for patients with end-stage renal disease. Eur J Clin Invest. 2020:e13266.
- 9. Zhang Y. Relationship between fibrinogen/albumin ratio and early renal damage markers in patients with hypertension. Research Square. 2021.
- 10. Zoccali C, Benedetto FA, Mallamaci F, et al. Inflammation is associated with carotid atherosclerosis in dialysis patients. Creed Investigators. Cardiovascular Risk Extended Evaluation in Dialysis Patients. J Hypertens. 2000;18:1207-1213.
- 11. Xia W, Kuang M, Li C, et al. Prognostic Significance of the Albumin to Fibrinogen Ratio in Peritoneal Dialysis Patients. Front Med (Lausanne). 2022;9:820281.
- 12. Bender M, Haferkorn K, Tajmiri-Gondai S , et al. Fibrinogen to Albumin Ratio as Early Serum Biomarker for Prediction of Intra-Hospital Mortality in Neurosurgical Intensive Care Unit Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med. 2022;11:4214.
- 13. Li S, Shen Y, Chang B, Wang N. Prognostic Value of Albumin-to-Fibrinogen Ratio for 28-Day Mortality among Patients with Sepsis from Various Infection Sites. Mediators Inflamm. 2022;2022:3578528.
- 14. Irish A. Cardiovascular disease, fibrinogen and the acute phase response: associations with lipids and blood pressure in patients with chronic renal disease. Atherosclerosis. 1998;137:133-139.
- 15. Zhang DP, Mao XF, Wu TT, et al. The Fibrinogen-to-Albumin Ratio Is Associated With Outcomes in Patients With Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention. Clin Appl Thromb Hemost. 2020;26:1076029620933008.
- 16. Wang P, Yuan D, Zhang C, et al. High fibrinogen-to-albumin ratio with type 2 diabetes mellitus is associated with poor prognosis in patients undergoing percutaneous coronary intervention: 5-year findings from a large cohort. Cardiovasc Diabetol. 2022;21:46.
- 17. Wang K, Xu W, Zha B, et al. Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease. Diabetes Metab Syndr Obes. 2021;14:4557-4567.
- 18. Bao J, Gao Z, Hu Y, et al .Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study. BMC Cardiovascular Disorders. 2023;23:432.
- 19. Zhu Y, Tao S, Zhang D, et al. Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease: a retrospective study. PeerJ. 2022;10:e13550.
- 20. Wang IK, Wang ST, Lin CL, et al. Early prognostic factors in patients with acute renal failure requiring dialysis. Ren Fail. 2006;28:43-49.
- 21. Albayrak T, Muhtaroğlu A. The Relationship Between APACHE II Score and Immunological Parameters in Intensive Care Patients. Van Medical Journal. 2023;30:367-373.22. Rathore SS, Oberoi S, Iqbal K, et al. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: A meta-analysis. Rev Med Virol. 2022;32:e2390.
- 23. Richter B, Sulzgruber P, Koller L, et al. Blood urea nitrogen has additive value beyond estimated glomerular filtration rate for prediction of longterm mortality in patients with acute myocardial infarction. Eur J Intern Med. 2019;59:84-90.
- 24. Kirtane AJ, Leder DM, Waikar SS, et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol. 2005;45:1781-1786.
Abstract
Objectives: Renal failure is linked to both acute and chronic inflammatory processes for a number of reasons, particularly in end-stage renal disease. Although it has demonstrated potential as an inflammatory marker in a number of diseases, the fibrinogen-to-albumin ratio’s (FAR) predictive significance in critically ill dialysis patients is yet unknown. The purpose of this study was to look into FAR as a possible mortality predictive indicator in this particular patient population.
Materials and Methods: A retrospective analysis of 226 patients admitted to the intensive care units of internal medicine and anesthesia, undergoing dialysis between 12.12.2021 and 15.12.2023, was conducted. Inclusion criteria were age ≥18, diagnosis of albumin or kidney disease, and availability of complete clinical and laboratory data. Exclusion criteria included anemia unrelated to kidney disease and inability to access relevant data. Demographic, clinical, and laboratory variables were collected, and statistical analyses were performed.
Results: The study revealed significant associations between mortality and lower body mass index, higher APACHE II score, elevated creatinine levels, lower glomerular filtration rate, higher albumin levels, and increased FAR. With an 81.75% sensitivity, 39.00% specificity, 62.80% positive predictive value, and 62.90% negative predictive value, the FAR cut-off point for mortality was found to be 241. Area under the curve of 58.1% was shown by receiver operating characteristic analysis.
Conclusion: FAR shows promise as a prognostic indicator for mortality in intensive care dialysis patients. While further prospective and multicenter studies are needed to validate its clinical usability, FAR could contribute to enhanced prognostic assessments and improved patient care in this specific population.
Key Words: Fibrinogen albumin ratio, mortality, acute kidney injury, chronic kidney disease
Ethical Statement
Ethical approval from the Giresun Training and Research Hospital Local Ethics Committee was obtained with decision number 37 on 18.12.2023
Supporting Institution
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Project Number
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Thanks
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References
- 1. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002;15:329-337.
- 2. Tai H, Zhu Z, Mei H, et al. Albumin-to-Fibrinogen Ratio Independently Predicts 28-Day Mortality in Patients with Peritonitis-Induced Sepsis. Mediators Inflamm. 2020;2020:7280708.
- 3. Xiao, L, Jia, Y, Wang X, et al. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clinica Chimica Acta. 2019;493:8-13.
- 4. Gao K, Zhang Y, Sun S, et al. Novel inflammatory markers in the blood of patients with knee synovitis. J Int Med Res. 2021;49:3000605211029557.
- 5. You X, Zhou Q, Song J, et al. (2019). Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy. BMC Cancer. 2019;19:931.
- 6. Ruan Y, Yuan C, Liu Y, et al. High fibrinogen-to-albumin ratio is associated with hemorrhagic transformation in acute ischemic stroke patients. Brain Behav. 2021;11:e01855.
- 7. Xia W, Li C, Yao X, et al. Prognostic value of fibrinogen to albumin ratios among critically ill patients with acute kidney injury. Intern Emerg Med. 2022;17:1023-1031.
- 8. Zou Y, Zhu Z, Zhou J, et al. Fibrinogen/Albumin ratio: A more powerful prognostic index for patients with end-stage renal disease. Eur J Clin Invest. 2020:e13266.
- 9. Zhang Y. Relationship between fibrinogen/albumin ratio and early renal damage markers in patients with hypertension. Research Square. 2021.
- 10. Zoccali C, Benedetto FA, Mallamaci F, et al. Inflammation is associated with carotid atherosclerosis in dialysis patients. Creed Investigators. Cardiovascular Risk Extended Evaluation in Dialysis Patients. J Hypertens. 2000;18:1207-1213.
- 11. Xia W, Kuang M, Li C, et al. Prognostic Significance of the Albumin to Fibrinogen Ratio in Peritoneal Dialysis Patients. Front Med (Lausanne). 2022;9:820281.
- 12. Bender M, Haferkorn K, Tajmiri-Gondai S , et al. Fibrinogen to Albumin Ratio as Early Serum Biomarker for Prediction of Intra-Hospital Mortality in Neurosurgical Intensive Care Unit Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med. 2022;11:4214.
- 13. Li S, Shen Y, Chang B, Wang N. Prognostic Value of Albumin-to-Fibrinogen Ratio for 28-Day Mortality among Patients with Sepsis from Various Infection Sites. Mediators Inflamm. 2022;2022:3578528.
- 14. Irish A. Cardiovascular disease, fibrinogen and the acute phase response: associations with lipids and blood pressure in patients with chronic renal disease. Atherosclerosis. 1998;137:133-139.
- 15. Zhang DP, Mao XF, Wu TT, et al. The Fibrinogen-to-Albumin Ratio Is Associated With Outcomes in Patients With Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention. Clin Appl Thromb Hemost. 2020;26:1076029620933008.
- 16. Wang P, Yuan D, Zhang C, et al. High fibrinogen-to-albumin ratio with type 2 diabetes mellitus is associated with poor prognosis in patients undergoing percutaneous coronary intervention: 5-year findings from a large cohort. Cardiovasc Diabetol. 2022;21:46.
- 17. Wang K, Xu W, Zha B, et al. Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease. Diabetes Metab Syndr Obes. 2021;14:4557-4567.
- 18. Bao J, Gao Z, Hu Y, et al .Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study. BMC Cardiovascular Disorders. 2023;23:432.
- 19. Zhu Y, Tao S, Zhang D, et al. Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease: a retrospective study. PeerJ. 2022;10:e13550.
- 20. Wang IK, Wang ST, Lin CL, et al. Early prognostic factors in patients with acute renal failure requiring dialysis. Ren Fail. 2006;28:43-49.
- 21. Albayrak T, Muhtaroğlu A. The Relationship Between APACHE II Score and Immunological Parameters in Intensive Care Patients. Van Medical Journal. 2023;30:367-373.22. Rathore SS, Oberoi S, Iqbal K, et al. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: A meta-analysis. Rev Med Virol. 2022;32:e2390.
- 23. Richter B, Sulzgruber P, Koller L, et al. Blood urea nitrogen has additive value beyond estimated glomerular filtration rate for prediction of longterm mortality in patients with acute myocardial infarction. Eur J Intern Med. 2019;59:84-90.
- 24. Kirtane AJ, Leder DM, Waikar SS, et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol. 2005;45:1781-1786.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Articles |
| Authors | |
| Project Number | - |
| Publication Date | March 28, 2024 |
| Submission Date | January 10, 2024 |
| Acceptance Date | February 1, 2024 |
| Published in Issue | Year 2024 Volume: 77 Issue: 1 |
