Fibrinogen Albumin Ratio and Ischemic Stroke During Venoarterial Extracorporeal Membrane Oxygenation.
Fibrinogen Albumin Ratio and Ischemic Stroke During Venoarterial Extracorporeal Membrane Oxygenation.
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DOI：
10.1097/mat.0000000000000992
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发表时间：
2020-03
期刊：
影响因子：
--
通讯作者：
Saeed O
中科院分区：
文献类型：
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作者：
Acharya P;Jakobleff WA;Forest SJ;Chinnadurai T;Mellas N;Patel SR;Kizer JR;Billett HH;Goldstein DJ;Jorde UP;Saeed O
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。总而言之，纤维蛋白原白蛋白比率（FAR）升高被描述为血栓前疾病严重程度的标志。我们评估了静脉动脉体外膜氧合 (VA ECMO) 支持期间 FAR 与缺血性卒中的关联。进行了一项单中心回顾性研究，包括所有接受 VA ECMO 的成年患者。 FAR 是根据 VA-ECMO 启动后前 24 小时内的纤维蛋白原和白蛋白测量值计算得出的。患者被分为高（≥125）和低（<125）FAR 组，并确定最终缺血性中风的风险。有 201 名患者接受了 VA ECMO 置入，其中 157 名患者接受了 FAR。他们的年龄为 56 ± 14 岁，其中 66 人 (42%) 的 FAR 较高。 FAR 高的患者在 VA ECMO 期间无缺血性卒中的生存率较低（对数等级 p < 0.001；调整后的风险比 5.51；95% CI：1.8–16.5）。在三分位数分析中，FAR 水平与最终缺血性中风的可能性增加相关（对数等级 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 放置的前 24 小时内 FAR 升高与随后发生缺血性中风的风险增加相关。我们的研究结果表明，在 VA ECMO 放置后立即评估 FAR 可能有助于对有缺血性中风风险的患者进行早期分层。
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.