High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia?

So you described something, but DID NOTHING USEFUL THAT WILL HELP STROKE PATIENTS RECOVER. Why the fuck are you in stroke anyway?  We've known about this pneumonia for years why don't you come up with a solution to prevent it?

• 11% Stroke-associated pneumonia (1 post to October 2020)

 

High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia?

Gangqiang Lin^1†, Minlei Hu^2†, Jiaying Song^3†, Xueqian Xu¹, Haiwei Liu¹, Linan Qiu¹, Hanyu Zhu¹, Minjie Xu³, Dandan Geng¹, Lexuan Yang¹, Guiqian Huang^1*, Jincai He^1* and Zhen Wang^1*

• ¹Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
• ²Department of Neurology, The First Hospital of Jiaxing, Jiaxing, China
• ³School of Mental Health, Wenzhou Medical University, Wenzhou, China

Background: Stroke-associated pneumonia (SAP) is associated with poor prognosis after acute ischemic stroke (AIS).

Purpose: This study aimed to describe the parameters of coagulation function and evaluate the association between the fibrinogen-to-albumin ratio (FAR) and SAP in patients with AIS.

Patients and methods: A total of 932 consecutive patients with AIS were included. Coagulation parameters were measured at admission. All patients were classified into two groups according to the optimal cutoff FAR point at which the sum of the specificity and sensitivity was highest. Propensity score matching (PSM) was performed to balance potential confounding factors. Univariate and multivariate logistic regression analyses were applied to identify predictors of SAP.

Results: A total of 100 (10.7%) patients were diagnosed with SAP. The data showed that fibrinogen, FAR, and D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT) were higher in patients with SAP, while albumin was much lower. Patients with SAP showed a significantly increased FAR when compared with non-SAP (P < 0.001). Patients were assigned to groups of high FAR (≥0.0977) and low FAR (<0.0977) based on the optimal cut-off value. Propensity score matching analysis further confirmed the association between FAR and SAP. After adjusting for confounding and risk factors, multivariate regression analysis showed that the high FAR (≥0.0977) was an independent variable predicting the occurrence of SAP (odds ratio =2.830, 95% CI = 1.654–4.840, P < 0.001). In addition, the FAR was higher in the severe pneumonia group when it was assessed by pneumonia severity index (P = 0.008).

Conclusions: High FAR is an independent potential risk factor of SAP, which can help clinicians identify high-risk patients with SAP after AIS.

Introduction

Stroke-associated pneumonia (SAP) is one of the most common complications among patients with acute ischemic stroke (AIS), taking place most frequently within the first week of stroke onset (1–3). The incidence of SAP ranges from 6.7 to 37.98% (4–6). Patients with SAP are more likely to have a worse outcome than patients with non-SAP, namely, poor functional prognosis, excessive time in hospital, and an increased risk of disability, 30-day and 1-year mortality (7–9). In addition, a retrospective cohort study including 14,702 patients with AIS found that pneumonia was significantly associated with the development of non-pneumonia medical complications, such as gastrointestinal bleeding, urinary tract infection, and recurrent stroke (10). Several clinical trials have shown that prophylactic use of antibiotics was ineffective to prevent SAP (11, 12).

Numerous studies have discovered various risk factors for SAP such as old age, being male, stroke severity, dysphagia, and diabetes (5, 9, 13). Moreover, researchers created several predictive models with these risk factors (4, 14–17), among which the A2DS2 score [age, atrial fibrillation (AF), dysphagia, sex, and severity] was considered to have a good predictive capacity (18). In a consecutive cohort of 1,569 patients with AIS, Gong et al. proved that the A2DS2 score could effectively predict the development of SAP in the Chinese population (19). However, SAP prediction is still a challenge due to its atypical clinical symptoms and the low accuracy of X-ray images (20). Therefore, it is necessary for us to look for valid predictors to diagnose SAP as early as possible.

It has long been known that there exists a wide range of interplay between inflammation and coagulation. For instance, inflammation spikes immediately after injury. Aggregated platelets and neutrophils release factors that stimulate the coagulation cascade in acute lung disease (21).

The fibrinogen-to-albumin ratio (FAR) which combines coagulation with nutritional status, is a new vital inflammatory biomarker for a variety of diseases, such as cervical cancer, oligodendroglial gliomas, acute coronary syndrome, and stroke (22–25). Zheng et al. found that a high FAR level on admission was highly associated with 3-month mortality and disability in patients with acute lacunar stroke (22). Yet, the link between FAR and the risk of developing SAP in patients after AIS remains unclear. The pneumonia severity index (PSI) is one of the best-known predictors for prognosis, containing 20 variables covering demography, clinical features, physical examination, laboratory examination, and chest radiography (26). A decade after PSI was founded, Aujesky et al. proved that PSI could effectively predict mortality and other adverse outcomes of low-risk patients and provided useful feedback to guide initial treatment (27).

Here, we aimed to explore the relationship between SAP and FAR in a retrospective cohort, which might provide an easily available and economical predictor for SAP.

More at link.