Fibrinogen Albumin Ratio and Ischemic Stroke During Venoarterial Extracorporeal Membrane Oxygenation. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Acharya, Prakash; Jakobleff, William A.; Forest, Stephen J.; Chinnadurai, Thiru; Mellas, Nicolas; Patel, Snehal R.; Kizer, Jorge R.; Billett, Henny H.; Goldstein, Daniel J.; Jorde, Ulrich P.; Saeed, Omar
• Is Part Of: ASAIO journal. Volume 66:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: albumin -- fibrinogen -- stroke -- VA ECMO; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000000992
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text.