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The Change in Fibrinogen is Associated with Outcome in Patients with Acute Ischemic Stroke Treated with Endovascular Thrombectomy

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Abstract

Background

Fibrinogen has been identified as a modulator of the coagulation and inflammatory process. There is uncertainty about the relationship between the dynamic profile of fibrinogen levels and its impact on clinical outcomes in patients with acute ischemic stroke treated with endovascular thrombectomy.

Methods

We consecutively enrolled patients with acute ischemic stroke who underwent endovascular thrombectomy. Fibrinogen was measured on admission and during hospitalization. The change in fibrinogen (Δfibrinogen) was calculated as the highest follow-up fibrinogen minus admission fibrinogen, with a positive Δfibrinogen indicating an increase in fibrinogen level. Functional outcome was assessed by the modified Rankin Scale at 3 months. Poor outcome was defined as modified Rankin Scale > 2.

Results

A total of 346 patients were included (mean age 67.4 ± 13.6 years, 52.31% men). The median fibrinogen on admission was 2.77 g/L (interquartile range 2.30–3.39 g/L). The median Δfibrinogen was 1.38 g/L (interquartile range 0.27–2.79 g/L). Hyperfibrinogenemia (> 4.5 g/L) on admission was associated with an increased risk of poor outcome [odds ratio (OR) 5.93, 95% confidence interval (CI) 1.44–24.41, p = 0.014]. There was a possible U-shaped association of Δfibrinogen with outcomes, with an inflection point of − 0.43 g/L (p = 0.04). When Δfibrinogen was <  − 0.43 g/L, a higher decrease in fibrinogen (lower Δfibrinogen value) was associated with a higher risk of poor outcome (OR 0.22, 95% CI 0.02–2.48, p = 0.219). When Δfibrinogen was >  − 0.43 g/L, the risk of poor outcome increased with increasing fibrinogen (OR 1.27, 95% CI 1.04–1.54, p = 0.016).

Conclusions

In patients with endovascular thrombectomy, hyperfibrinogenemia on admission was associated with poor functional outcomes at 3 months, whereas Δfibrinogen was associated with poor 3-month outcomes in a possible U-shaped manner.

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Funding

This work was supported by the National Natural Science Foundation of China (81870937, 82071320, 82271328, and 82102656), the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project of West China Hospital at Sichuan University (2020HXFH012, 2021HXFH043), Sichuan Science and Technology Program (2019YJ0037), Natural Science Foundation of Sichuan Province (2023NSFSC1580, 2022NSFSC1392), China Postdoctoral Science Foundation (2022T150452,2021M692299), and PostDoctor Research Project, West China Hospital, Sichuan University (2021HXBH021).

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Authors and Affiliations

  1. Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Changyi Wang, Ting Cui, Shucheng Li, Jingyu Cui, Luyao Zhong, Shuai Jiang, Mingxi Chen, Yuan Yang, Anmo Wang, Xuening Zhang, Wenzuo Shang, Zilong Hao & Bo Wu

  2. Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Changyi Wang

  3. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Changyi Wang & Tiantian Wang

  4. The Second Department of Neurology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China

    Qiange Zhu

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  1. Changyi Wang
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Contributions

BW and ZH conceived and designed the study. CW, TC, SL, TW, JC, LZ, SJ, QZ, MC, YY, AW, XZ and WS acquired the data, which CW analyzed. CW, TC, SL, TW, and JC aided in data interpretation. CW wrote the article. All authors were involved in revising the article and approved the final version.

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Correspondence to Bo Wu.

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Wang, C., Cui, T., Li, S. et al. The Change in Fibrinogen is Associated with Outcome in Patients with Acute Ischemic Stroke Treated with Endovascular Thrombectomy. Neurocrit Care 40, 506–514 (2024). https://doi.org/10.1007/s12028-023-01768-4

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