Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome

Abstract

BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies. AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS). METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded. RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006). CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.

Albumin Is a Component of the Esterase Status of Human Blood Plasma

“…The level of albumin in the survivors and non-survivors was statistically significantly lower by 18 and 27%, respectively, relative to the control, whereas for the total protein, a statistically significant decrease of 11% was noted only for the group of deceased patients. This indicates, firstly, the critical role of albumin in the outcome of the disease and the high significance of this indicator for future risk stratification, which is confirmed by numerous data from other researchers [ 18 , 22 , 46 , 53 ], and secondly, the preservation of the protein-synthesizing function of the liver in patients with a negative prognosis, and even some increase in it, mainly due to the synthesis of CRP when stimulated by pro-inflammatory cytokines [ 60 ]. The esterase activity of albumin does not undergo significant changes, while the activity of PON1 in both groups of COVID-19 patients, regardless of the outcome, significantly decreases by 35%.…”

“…Thus, the index [Urea] × [MDA]/(BChEb × [ALB]) can claim to take a place among the most promising indices proposed to date, among which there is none that includes the activity of BChE and at the same time demonstrates such striking differences at the stage of admission to the clinic between survivors and those who died during treatment from COVID-19. At the same time, it should be mentioned that most of the proposed indices include albumin in the denominator: LDH/[ALB], [Lact]/[ALB], [Fibr]/[ALB], [Urea]/[ALB], and [CRP]/[ALB] [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Importantly, correlation analysis independent of age and concomitant pathology showed that the ratio of [CRP]/[ALB] negatively correlates with oxygen saturation (SO 2 ), spirometric indices (FEV1, forced expiratory volume in the first second, and FVC, forced volume capacity) and lung diffusion values (DLCO, carbon monoxide diffusion capacity) [ 52 ].…”

Prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with chronic heart failure across the different ejection fraction spectrum

“…Numerous studies have demonstrated that the FAR is associated with an adverse prognosis in many cancers and has been frequently studied in cardiovascular diseases (CVDs), particularly CAD [ 13 , 14 , 16 , 18 , 39 , 40 ]. However, there is no evidence that reducing fibrinogen or correcting hypoproteinaemia can improve the prognosis of CVD, including HF.…”

Acute myocardial infarction in myeloproliferative neoplasms

“…MPN inflammation is dependent and independent of the mutational landscape of the disease and is influenced not only by genetics, but also by the immune system, diet, metabolism, and comorbidities[ 59 ]. Furthermore, researchers have pointed out that both MPN patients[ 58 ] and MI subjects have elevated concentrations of ferritin[ 60 , 61 ], C-reactive protein[ 62 , 63 ], and fibrinogen[ 64 ]. Pro-inflammatory cytokines, such as tumor necrosis factor-alpha, interleukin (IL)-6 and IL-1, and the NACHT, LRR, and PYD domains-containing protein 3 inflammasome have been reported to contribute to the pathogenesis of both MI[ 65 - 67 ] and MPN[ 58 , 59 , 68 - 70 ].…”