From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
ASAIO J. 2020 Mar;66(3):277-282. doi: 10.1097/MAT.0000000000000992.
Fibrinogen is a clotting factor and a major determinant of platelet aggregation. Albumin, on the other hand, inhibits platelet function and thrombus formation. Taken together, an elevated fibrinogen albumin ratio (FAR) has been described as a marker of disease severity during prothrombotic conditions. We evaluated the association of FAR and ischemic stroke during venoarterial extracorporeal membrane oxygenation (VA ECMO) support. A single center, retrospective study was performed including all adult patients placed on VA ECMO. FAR was calculated from fibrinogen and albumin measurements in the first 24 hours of VA-ECMO initiation. Patients were categorized into high (≥125) and low (<125) FAR groups and the risk of eventual ischemic stroke was determined. There were 201 patients who underwent VA ECMO placement and 157 had a FAR. They were 56 ± 14 years old and 66 (42%) had a high FAR. Patients with a high FAR had lower survival free from an ischemic stroke during VA ECMO (log rank p < 0.001; adjusted hazard ratio 5.51; 95% CI: 1.8-16.5). In tertile analysis, the level of FAR was associated with an incrementally higher likelihood of eventual ischemic stroke (log rank p = 0.004). Those with a high FAR had greater mean platelet volume (10.8[10.4-12] vs. 10.5[10.2-11.9]fl, p = 0.004). An elevated FAR during the first 24 hours of VA ECMO placement is associated with a greater risk of a subsequent ischemic stroke. Our findings suggest that assessment of FAR soon after VA ECMO placement may assist with early stratification of patients at risk for an ischemic stroke.
纤维蛋白原是一种凝血因子，也是血小板聚集的主要决定因素。另一方面，白蛋白抑制血小板功能和血栓形成。总的来说，纤维蛋白原白蛋白比值（FAR）升高已被描述为血栓形成前状态下疾病严重程度的标志物。我们评估了 FAR 与静脉-动脉体外膜肺氧合（VA-ECMO）支持期间缺血性卒中的关系。这项单中心回顾性研究纳入了所有接受 VA-ECMO 治疗的成年患者。FAR 是根据 VA-ECMO 启动后 24 小时内纤维蛋白原和白蛋白的测量值计算得出的。患者分为 FAR 高（≥125）和 FAR 低（<125）组，并确定最终发生缺血性卒中的风险。共有 201 名患者接受了 VA-ECMO 治疗，其中 157 名患者有 FAR。他们的年龄为 56±14 岁，66 名（42%）患者 FAR 高。在 VA-ECMO 期间，FAR 高的患者无缺血性卒中的生存率较低（对数秩检验 p<0.001；调整后的危险比 5.51；95%CI：1.8-16.5）。在三分位分析中，FAR 水平与最终发生缺血性卒中的可能性呈递增关系（对数秩检验 p=0.004）。FAR 高的患者平均血小板体积较大（10.8[10.4-12] vs. 10.5[10.2-11.9]fl，p=0.004）。VA-ECMO 放置后 24 小时内 FAR 升高与随后发生缺血性卒中的风险增加相关。我们的研究结果表明，VA-ECMO 放置后早期评估 FAR 可能有助于对缺血性卒中风险患者进行早期分层。
