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Aim. To study the relationship between the symptoms of nutritional insufficiency and systemic inflammation in cancer palliative patients. Methods. 106 palliative cancer patients were examined at Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine: 54 (50.9%) men and 52 (49.1%) women aged 61 [54; 67] years. All patients underwent laboratory and instrumental examination within the approved standards of specialized medical care. Systemic inflammation was assessed by the levels of acute phase proteins (C-reactive protein, fibrinogen). The study of integrated clinical and laboratory, somatometric parameters was carried out. The nutritional risk index was assessed. Results. Palliative cancer patients showed a statistically significant decrease in the concentration of hemoglobin, lymphocytes, and albumin. The activation of systemic inflammation that manifested by hyperfibrinogenemia and an increase in the level of C-reactive protein was revealed. The study of somatometric parameters revealed a statistically significant decrease in body mass index, shoulder circumference, subscapular skinfold thickness, and a tendency to reduce lean body mass. The nutritional risk index assessment showed mild nutritional insufficiency in 22 (20.8%) of the examined patients and severe nutritional insufficiency in 28 (26.4%) patients. The maximum diagnostic significance of the level of C-reactive protein for prediction the nutritional insufficiency was achieved at 80.4% sensitivity and 52.7% specificity (AUC=0.671, 95% confidence interval [0.573; 0.759], p=0.001), which corresponded to a C-reactive protein threshold of 31 mg/l. Conclusion. 50 (47.2%) of the examined patients showed signs of nutritional insufficiency, a statistically significant decrease in hemoglobin and albumin concentration, as well as lymphocyte count, activation of systemic inflammation, manifested by hyperfibrinogenemia, and an increase in the level of C-reactive protein; it was revealed a statistically significant relationship between C-reactive protein level and malnutrition.

Aim Coronavirus disease (COVID‐19) is characterized by pneumonia with secondary damage to multiple organs including the liver. Liver injury (elevated alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) often correlates with disease severity in COVID‐19 patients. The aim of this study is to identify pathological microthrombi in COVID‐19 patient livers by correlating their morphology with liver injury, and examine hyperfibrinogenemia and von Willebrand factor (vWF) as mechanisms of their formation. Methods Forty‐three post‐mortem liver biopsy samples from COVID‐19 patients were obtained from Papa Giovanni XXIII Hospital in Bergamo, Italy. Three morphological features of microthrombosis (sinusoidal erythrocyte aggregation [SEA], platelet microthrombi [PMT], and fibrous thrombi) were evaluated. Results We found liver sinusoidal microthrombosis in 23 COVID‐19 patients (53%) was associated with a higher serum ALT and AST level compared to those without (ALT: 10‐fold, p = 0.04; AST: 11‐fold, p = 0.08). Of 43 livers, PMT and SEA were observed in 14 (33%) and 19 (44%) cases, respectively. Fibrous thrombi were not observed. Platelet microthrombi were associated with increased ALT (p

Purpose This article aimed to study the prognostic value of preoperative plasma fibrinogen and CA19-9 in non-distant metastatic breast cancer (BC). Patients and Methods A total of 343 non-distant metastatic BC patients were included in this study. The optimal cut-off values of plasma fibrinogen and CA19-9 were obtained by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to evaluate prognostic factors for overall survival (OS). Survival data were assessed using Kaplan-Meier survival analysis with the Log-rank test. Based on the cut-off values, we classified the fibrinogen-CA19-9 score as follows: 2 (both hyperfibrinogenemia and high CA19-9), 1 (either hyperfibrinogenemia or high CA19-9), and 0 (neither hypefibrinogenemia nor high CA19-9). Results Our follow-up time totaled 10 years, the median follow-up time was 77 months (range=2-119 months), and 82 (23.9%) of 343 patients died during the follow-up period. The optimal cut-off values of plasma fibrinogen and CA19-9 were 2.805 g/L and 11.85 U/mL, respectively. The multivariate Cox analysis results suggested that there was a significant association between worse OS and elevated preoperative plasma fibrinogen and CA19-9 levels (HR=2.016, 95% CI=1.216-3.342, P=0.007; and HR=2.042, 95% CI=1.282-3.253, P=0.003). The area under the ROC curve (AUC) increased from 0.589 (for plasma fibrinogen) and 0.594 (for CA19-9) to 0.640 when these two parameters were combined. When we added this combined factor to the multivariate analysis, it was an independent prognostic factor for BC (P

BACKGROUND: Type II diabetes, fibrinogen levels have been demonstrated to predict the progression to overt nephropathy. Hyperfibrinogenemia, an indicator of inflammation, is also associated with the presence of endothelial dysfunction, insulin resistance, hypercoagulability, and increased blood viscosity and is a marker of unstable atherosclerotic lesions. AIM: This study aimed to evaluation of coagulation profile and D-dimer and estimation of Serum Fibrinogen Level in Sudanese Patients with type II Diabetes Mellitus in Khartoum State. METHODS: A questionnaire was designed to collect information about the study group, Blood sample were collected from all participants in Tri sodium citrate containers. Automated coagulometer (COATRON M1) was used to evaluate prothrombine time and activated partial thromboplastine time and measure fibrinogen level. D-dimer levels were evaluated using (ichroma™) Reader fluorescence scanning instrument an integrated Point of Care Test (POCT) system. RESULTS: The study showed that the mean and standard of PT, APTT, INR was (17.9 ± 3.8 sec, 32.6 ± 4.1 sec, 1.1 ± 0.3 respectively), the mean of age among study group was (53 ± 14.2 years), there was significant different when correlate PT and management of disease (p. value 0.01) . the present study show insignificant correlation between PT and treatment, complication and gender (0.20 , 0.13 and 0.08) respectively while APTT there was significant difference with management ,complication and gender p. value was (0.01 , 0.03 and 0.01 respectively) .The mean ± SD of fibrinogen level was 136 ± 20.7 ,the mean ± SD of fibrinogen level in male was 137.4 ± 20.6mg/dl and in female was 135.22 ± 20.9 mg/dl. The present study show the insignificant correlation among gender p-value was (0.594). The frequency of duration of disease in group less than 5 years was (34%), in 5-10 years was (41%) and in group more than 10 years was (25%). Statistically insignificant differences between fibrinogen level and duration of disease were observed p-value (0.776), there was insignificant difference between fibrinogen level and different age group p. value (0.66). The mean of D-dimer levels is (1309.3 ± 324.1mg /ml). CONCLUSION: The present study show that shortened prothrombin time, activated partial thromboplastin time, shortened PT and APTT might be useful haemostatic markers in diabetic patients, especially in those at high risk for thrombotic complications. The Mean of plasma fibrinogen level in patient with type II diabetics mellitus were136.3mg/dl, insignificant correlation with Fibrinogen levels with age, gender and duration of disease. The D. Dimer level show significant increase.

Objective To investigate the clinical features of COVID-19 cases in Suzhou China. Biomarkers were screened out of hematological parameters for risk stratification. Method Confirmed COVID-19 adult patients in Suzhou were included. The patient data was collected, and the results of laboratory examinations were compared between the mild/moderate and severe COVID-19 groups. A ROC was calculated to compare the diagnostic performance of candidate indexes, and dynamic levels of hematological indexes were compared between the two groups. Result 75 patients were enrolled, with a mean age of 46.6 ± 14 years, and 45 patients were male. All patients were classified into two groups: the mild/moderate group and the severe group. WBC, neutrophil to lymphocyte ratio (NLR), D-dimer, and fibrinogen levels of the severe group were significantly higher (P, Highlights • Most common symptoms of Suzhou COVID-19 are fever, cough and sore throat. • COVID-19 has characteristics of abnormal hematological indexes. • NLR and D-dimer can be used as valuable biomarkers for risk stratification of COVID-19.

Background. Hyperfibrinogenemia plays a crucial role in the coagulation cascade leading to the formation of clots. It is involved in the process of platelet aggregation, primary haemostasis, and leukocyte-endothelial cell interactions. The aim of our study was to assess the correlations between fibrinogen concentration and particular risk factors for vascular diseases and atherosclerotic changes in stroke patients. Methods. The study group consisted with 94 patients with acute ischaemic stroke with normo- or hyperglycaemia and normoor hyperlipidemia. 21 healthy subjects served as a control group. Fibrinogen level, HbA1c, and lipid profile were measured in all patients. Using a flow cytometer, we assessed CD61 positive microparticles which were defined as platelet-derived microparticles (PDMPs). The level of sP-selectin in serum was measured using the ELISA method. Results. A significant positive correlation was observed between fibrinogen concentration and sP-selectin (p = 0.001), HbA1c (p < 0.05) level, and percentage of PDMPs (p < 0.05) in the study patients. Furthermore, we noticed a significant negative correlation between fibrinogen concentration and the level of HDL (p < 0.05). No correlation was observed between fibrinogen and TC, LDL and TG levels. Conclusions and clinical implications. Our findings suggest that an elevated fibrinogen level may represent a marker of prothrombotic condition exacerbated in the state of hyperglycaemia and activation of platelets and endothelial cells. This suggests an important role played by fibrinogen in the process of thrombogenesis.

Objective The ROTEM sigma whole blood viscoelastic test uses different technology than the former delta model. Existing ROTEM based algorithms use cutoff values based on the delta model, and cannot be applied to the sigma model. The authors tested sensitivity and specificity of ROTEM sigma parameters to detect specific hemostatic deficiencies and established cutoff values with the aim of developing a treatment algorithm. Design Prospective observational evaluation of diagnostic accuracy. Setting This study was performed in a tertiary center. Participants Blood samples for standard laboratory tests (SLTs) and ROTEM sigma analysis were obtained from 14 healthy volunteers and 35 patients showing various hemostatic disorders (isolated factor deficiencies, von Willebrand's disease, thrombocytopenia, hypofibrinogenemia, hyperfibrinogenemia, and patients undergoing cardiac surgery). Intervention Correlation coefficients were calculated between SLTs and ROTEM parameters in the extrinsic pathway activation, intrinsic pathway activation, and extrinsic pathway activation with platelet inhibition tests. Receiver operator characteristics defined the values of ROTEM parameters, which best predict plasma fibrinogen level measured by Clauss method 37 seconds and 1.5 times the upper normal limit. Measurement and Main Results The combination of FIBTEM A5 ≤12 mm and EXTEM A5 ≤44 mm identified a fibrinogen level 80 seconds had a 25.0% sensitivity and a 100% specificity for a PT 204 seconds showed a sensitivity of 75.0% and a specificity of 97.4% for an aPTT >37 and a sensitivity of 100% and a specificity of 80.0% for an aPTT >55 seconds. Conclusion The authors present the first ROTEM sigma-based algorithm for the treatment of coagulopathic bleeding. The algorithm uses parameters with optimal sensitivity and specificity for critical values of SLTs determined from a heterogenous group of donors.

Introduction. One of the main factors involved in the pathogenesis of burn disease consists in the disturbance of microcirculation and haemostasis, caused by increased platelet aggregation. Mechanisms underlying the enhancement of platelet aggregation are poorly understood. Main results were obtained for adult patients at the onset of the burn disease, with no similar data on paediatric patients being available. There is evidence of a relationship between the size of platelets (MPV) and their functionality.Aim. To undertake a study of spontaneous and ADP-induced platelet aggregation and their size in children with burn disease.Materials and methods. We studied the aggregation and size of platelets in children aged 3–17 years, in whom burn areas covered 10–70 % of the body surface at the onset of the disease and before discharge. Spontaneous platelet aggregation was analysed under conditions of induced shear flow, whereas ADP-induced aggregation was studied employing a turbidimetric method. The study of platelet sizes was carried out using a conductometric method.Results. Spontaneous platelet aggregation increases significantly in children with burn disease. The integrated optical density of the formed aggregates, their area and perimeter were estimated for the first time. These indicators remained elevated even after burn wounds had been completely closed. In burn disease, changes in ADP-induced platelet aggregation were multidirectional in nature. Mean platelet volume (MPV) was increased during the acute period of burn disease, decreased during the period of toxaemia, and normalised by the time of patients’ discharge. Changes in MPV did not affect the aggregation properties of platelets. There was no correlation between the degree of aggregation and the severity of hyperfibrinogenemia. The blood of burn patients contained a large number of activated platelets, which was the reason for the increase in their spontaneous aggregation, not requiring the participation of exogenous inducers.Conclusion. An increase in spontaneous platelet aggregation was observed in children after a thermal injury, which remained elevated until the burn wounds were completely closed. A significant increase in the number of activated platelets constituted the reason for the increase in spontaneous platelet aggregation.Conflict of interest: the authors declare no confl ict of interest.Financial disclosure: the study had no sponsorship.

Original Article, Introduction: Previous studies have indicated that hyperfibrinogenemia is a predictor of poor prognosis in various tumors. However, little information is available on the prognostic impact of preoperative hyperfibrinogenemia and its changing pattern in resectable pancreatic ductal adenocarcinoma (PDAC) patients. Methods: This retrospective study examined 102 PDAC patients who underwent curative surgery at Omori Medical Center, Toho University School of Medicine (Tokyo, Japan) between 2004 and 2016. Among these, 44 (43.1%) reported preoperative hyperfibrinogenemia. Results: Preoperative hyperfibrinogenemia was associated with an independent prognostic factor for patient survival. The cumulative 5-year overall survival time rate in the normal fibrinogen and hyperfibrinogen groups was 44.8% and 31.2%, respectively, with a significant difference between the two groups (P = 0.047). The prognostic factors in PDAC patients revealed preoperative hyperfibrinogenemia of 〓400 mg/dL (P = 0.017). The cumulative 5-year overall survival rates were 57.3% and 9.1% in the normalization and non-normalization groups, respectively, with a significant difference between the two groups (P = 0.008). In multivariate analysis, the prognostic factors in patients with preoperative hyperfibrinogenemia revealed a postoperative fibrinogen level of 〓400 mg/dL (P = 0.001). Conclusions: Preoperative hyperfibrinogenemia was the risk factor for reducing overall survival in PDAC patients. Among the patients with hyperfibrinogenemia, the non-normalization group after surgery revealed to be a high-risk group for poor prognosis.

Background Gallbladder carcinoma (GBC) was the most common malignancy of biliary tract. Patients with malignancies frequently present with activated coagulation pathways, which might potentially related to tumor progression and prognosis. The purpose of the study was to investigate the clinical significance of preoperative serum fibrinogen levels and platelet counts in GBC patients. Methods The preoperative fasting serum fibrinogen levels and platelet counts of 58 patients with GBC were measured by AUV2700 automatic biochemical analyzer, as well as 60 patients with cholesterol polyps and 60 healthy volunteers. Kaplan–Meier survival analysis was applied to show the correction between fibrinogen levels and outcome after surgery. Results The fibrinogen levels of patients with GBC were significantly higher than healthy gallbladder and cholesterol polyp of gallbladder (p 0.05) in multivariate analysis. Conclusions The preoperative serum fibrinogen levels and platelet counts might be reliable biomarkers for the occurance of disease, tumor depth, lymph node metastasis, distant metastasis and advanced TNM stage in patients with GBC. The serum fibrinogen levels might be a prognostic factor to predict outcome for GBC patients suffering from surgery treatment. Anticoagulation therapy might be considered to control cancer progression in future studies.

Elevated plasma fibrinogen is associated with tumor progression and poor outcomes in several cancers. However, no studies have demonstrated the prognostic value of hyperfibrinogenemia in the setting of autologous hematopoietic stem cell transplantation (ASCT). We retrospectively reviewed 104 patients who were diagnosed with malignant lymphoma (ML) or multiple myeloma (MM) and underwent ASCT in our institution between 2007 and 2018. The patients included 63 men and 41 women with a median age of 58 years (range, 24-70 years). Forty-seven patients were diagnosed with ML, and 57 patients were diagnosed with MM. The median follow-up period was 59 months. The median pretransplant plasma fibrinogen levels were 336 mg/dL in ML patients and 320 mg/dL in MM patients. The Kaplan-Meier method revealed that patients with pretransplant hyperfibrinogenemia had a significantly shorter 5-year overall survival (OS) than those without hyperfibrinogenemia (5-year OS: 34.3% vs 81.0%, P .001). Among 27 patients with diffuse large B cell lymphoma, patients with pretransplant hyperfibrinogenemia (n = 12) had a significantly shorter OS than those without hyperfibrinogenemia (n = 15) (5-year OS: 40.0% vs 80.2%, P = .006). Among 57 MM patients, there was no significant difference in the 5-year OS between the high-fibrinogen group and the low-fibrinogen group (5-year OS: 77.1% vs 50.4%, P = .17). Our study suggested that pretransplant hyperfibrinogenemia was associated with a poor survival in patients with lymphoma who underwent ASCT. Because our results are based on a small-sized analysis, further large-scale prospective studies are warranted to verify this conclusion.

Purpose To fully elucidate the relationship of serum fibrinogen and the prognosis of esophageal squamous cell carcinoma. Methods The concentrations of serum fibrinogen were measured by the Clauss method in a total of 1331 operable esophageal squamous cell carcinoma (ESCC) patients from the past 3 years. The correlation of serum fibrinogen concentration and patient outcome and clinical pathological factors was tested. Results Hyperfibrinogenemia was significantly correlated with advanced pathological T stage and TNM stage. Serum fibrinogen was determined as a worse independent survival predictor in ESCC by survival analysis. The hazard ratio was 1.672 (95% confidence interval [CI] 1.043-2.681). A subgroup analysis further elucidated a significant correlation between hyperfibrinogenemia and younger age (P=0.011), being female (P=0.002), not having a history of smoking (p

Background This study aimed to evaluate the prognostic significance of plasma fibrinogen, serum albumin, the mean platelet volume (MPV), and the neutrophil-to-lymphocyte ratio (NLR) in patients with laryngeal squamous cell carcinoma (LSCC) who underwent surgical resection. Material/Methods A retrospective study included 110 patients with LSCC who underwent surgical resection between January 2008 to June 2015. Clinicopathologic and demographic data were recorded. Preoperative levels of plasma fibrinogen, serum albumin, MPV, and NLR were measured, and all patients underwent postoperative follow-up. The Kaplan-Meier method was used to determine the impact of these factors on overall survival (OS) and disease-free survival (DFS). Results Preoperative hyperfibrinogenemia was significantly correlated with clinical stage, T stage, and tumor location in patients with LSCC (P0.05). Patients with an MPV

It is well known that antithrombin (AT) deficiency results in decreased heparin sensitivity, also known as "heparin resistance." However, non-AT-mediated causes of heparin resistance are generally poorly characterized and less prevalent in the literature. We present 2 case reports of non-AT-mediated heparin resistance during cardiac surgery due to paraproteinemia and hyperfibrinogenemia. These cases highlight the challenges posed by unusual conditions in achieving adequate anticoagulation for cardiopulmonary bypass (CPB). The pros and cons of the treatment selections for these cases are discussed, and the potential complications of large doses of unfractionated heparin are considered.

Aim. To describe a case of arterial thrombosis with a thrombus that had atypical composition due to profound pathological changes in the cellular and protein composition of the blood. Methods. Scanning electron microscopy of an ex vivo thrombus extracted from the common femoral artery. Results. In the absence of platelets and leukocytes there was a significant prevalence of fibrin over other blood components in all layers of the arterial thrombus. There were no morphological signs of intravital contraction (retraction) characteristic for thrombi: single erythrocytes were not exposed compressive deformation, redistribution of fibrin and platelets within the thrombus toward the periphery. Formation of the atypical arterial thrombus in the vessel with atherosclerotic vessel damage is probably due to association with severe hyperfibrinogenemia and thrombocytopenia. Conclusion. The structure of a thrombus depends not only on its vascular location (arterial or venous), but also on the cellular and protein composition of the blood. These factors support diversification of antithrombotic therapy, considering composition and properties of thrombi irrespective of the place and hemodynamic conditions of their formation.

These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

Hyperfibrinogenemia and cancer-associated systemic inflammatory response are strongly associated with cancer progression and prognosis. We aimed to develop a novel prognostic score (F-SII score) on the basis of preoperative fibrinogen (F) and systemic immunoinflammatory index (SII), and evaluate its predictive value in patients with resectable gastric cancer (GC). Patients diagnosed with GC between January 2012 and December 2016 were reviewed. The F-SII score was 2 for patients with a high fibrinogen level (≥ 3.37 g/L) and a high SII (≥ 372.8), whereas that for patients with one or neither was 1 or 0, respectively. A high F-SII score was significantly associated with older patient age, a high ASA score, large tumor size, large proportion of perineural invasion, and late TNM stage. Multivariate analysis indicated that the F-SII score, histological grade, and TNM stage were independent factors for overall survival (OS). The Harrell's concordance index (C-index) of a nomogram based on the F-SII score and several clinicopathological manifestations was 0.72, which showed a better predictive ability for OS than the TNM stage alone (0.68). In conclusion, preoperative F-SII may serve as a useful predictive factor for OS and refine outcome prediction for patients with resectable GC combined with traditional clinicopathological analysis.

It has been previously indicated that preoperative plasma fibrinogen levels can correlate with cancer progression and be used as a useful predictor of lymph node metastasis or its premetastatic status such as lymphovascular invasion (LVI). In the present study, how preoperative plasma fibrinogen levels, considered in conjunction with other clinicopathological factors, can predict the presence of LVI and prognosisin patients with upper urinary tract urothelial carcinoma (UTUC) was examined. Medical records of 145 patients with UTUC who underwent radical nephroureterectomy (RNU) were retrospectively reviewed. The current study evaluated systemic inflammatory response markers including levels of plasma fibrinogen and other clinicopathological factors in orderto determine independent predictors of LVI and prognosis. The Cox proportional hazards model indicated that positive surgical margins and LVI were independent factors for poor cancer-specific survival (CSS) rates and extraurothelial recurrence-free survival (ERFS) rates. In addition, positive cytology, the presence of hydronephrosis and plasma fibrinogen levels were significant preoperative predictors of LVI. Furthermore, patients exhibiting two or more of higher fibrinogen levels (≥400 mg/dl), positive urine cytology and the presence of hydronephrosis were indicated to exhibit worse CSS or ERFS rates compared with patients exhibiting only one of the aforementioned factors or those with none of the three aforementioned factors in the multivariate analysis of the Cox proportional hazards model. In conclusion, hyperfibrinogenemia can be an independent predictor of the presence of LVI, and stratifying preoperative risk using fibrinogen levels, urine cytology and hydronephrosis can serve as the basis for selecting candidates for additional therapy before and/or after RNU in patients with UTUC.

Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of

While cancer is often related to hyperfibrinogenemia, it is rarely related to hypofibrinogenemia. Specifically, gastric cancer concomitant with unprovoked hypofibrinogenemia and the corresponding treatment approach have been rarely reported. We presented a case of gastric cancer in a 78-year-old Chinese woman in whom sudden, unprovoked refractory hypofibrinogenemia had been found during the whole brain radiotherapy despite stable clinical condition. Fibrinogen supplementation was not useful for controlling her level of fibrinogen. However, when she received sintilimab, an immunotherapy drug acting as programmed death receptor 1 inhibitor, to treat her gastric cancer, fibrinogen rose to the normal level. We also reviewed the literature to explore the causes of hypofibrinogenemia in tumor patients. This case suggests that we need to pay attention to tumor-related coagulation disorders, and monitoring coagulation indicators is essential. Treating primary disease by immunotherapy drugs may be an important method to improve the level of coagulation factors. This is the first report of sintilimab reversing a rare refractory hypofibrinogenemia in a patient with gastric cancer.

Coronavirus disease 2019 (COVID‐19) is a current global pandemic caused by the novel coronavirus SARS‐CoV‐2. Alongside its potential to cause severe respiratory illness, studies have reported a distinct COVID‐19‐associated coagulopathy that is characterized by elevated D‐dimer levels, hyperfibrinogenemia, mild thrombocytopenia, and slight prolongation of the prothrombin time. Studies have also reported increased rates of thromboembolism in patients with COVID‐19, but variations in study methodologies, patient populations, and anticoagulation strategies make it challenging to distill implications for clinical practice. Here, we present a practical review of current literature and uses a case‐based format to discuss the diagnostic approach and management of COVID‐19‐associated coagulopathy. Implications for Practice Coronavirus disease 2019 (COVID‐19)‐associated coagulopathy is characterized by elevated D‐dimer levels, hyperfibrinogenemia, and increased rates of thromboembolism. Current management guidelines are based on limited evidence from retrospective studies that should be interpreted carefully. At this time, all hospitalized patients with suspected or confirmed COVID‐19 should receive coagulation test surveillance and standard doses of prophylactic anticoagulation until prospective randomized controlled trials yield definitive information in support of higher prophylactic doses., This article presents a practical review of current literature and use a case‐based format to discuss the diagnostic approach and management of COVID‐19‐associated coagulopathy.

Hypercoagulability has been recognised as a common complication of COVID‐19. Exact mechanisms for this extreme coagulation activation have not yet been elucidated. However, one of the consistent laboratory finding is the increase in fibrinogen, in some cases, marked elevation. High circulating levels of fibrinogen have been linked to thrombosis for years and for this reason, hyper‐fibrinogenemia is considered one of the mechanisms for COVID‐19 coagulopathy. In this forum article, instead of the prothrombotic role, a protective function for fibrinogen is discussed. Fibrinogen, like the other well‐known acute phase reactants, is increased in COVID‐19 possibly to protect the host.

Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas worldwide. Previous studies indicated that hyperfibrinogenemia was a poor predictor in various tumors. The purpose of our study was to evaluate the prognostic effect of hyperfibrinogenemia in DLBCL. Data of 228 patients, who were diagnosed with DLBCL in our hospital between May 2009 and February 2016, were analyzed retrospectively. The Kaplan-Meier method and Cox regression were performed to find prognostic factors associated with progression-free survival (PFS) and overall survival (OS). Receiver operator characteristic (ROC) curve and the areas under the curve were used to evaluate the predictive accuracy of predictors. Comparison of characters between groups indicated that patients with high National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) score (4-8) and advanced stage (III-IV) were more likely to suffer from hyperfibrinogenemia. The Kaplan-Meier method revealed that patients with hyperfibrinogenemia showed inferior PFS (P

Increase of fibrinogen concentration in type 2 diabetic patients is an indicator for vascular inflammation, endothelial dysfunction. Hyperfibrinogenemia is a strong marker and independently for atherosclerosis. Beside that, hyperfibrino -genemia can precede macroand microvascular complication. In type 2 diabetic, microalbuminuria is early marker for diabetic nephropathy and show that there isendothelial dysfunction. Microalbuminuria not only useful to predict renal damage, but also useful to predict cardiovascular damage.Microalbuminuria is a marker for endothelial dysfunction. To know the correlation between increase of fibrinogen concentration andmicroalbuminuria in type 2 diabetic patients. The study was performed in Dr. M. Djamil central Hospital by using cross sectionalmethod and consecutive random sampling. Sample were type 2 diabetic patients included criteria were measured albumin/ creatinineratio and the patients was divided in 2 group, that is group A (normoalbuminuria) and group B (microalbuminuria) with totalsample were 90 patients. Each group were performed measurement of albumin/ creatinine ratio, random glucose concentration, andfibrinogen concentration in plasma. In group A, we found the average of albumin/ creatinine ratio is 6.6 μg/mg and in group B is107.5 μg/mg. The average of random glucose concentration in group A is 181.3 mg/dl, and in group B is 204 mg/dl and the difference of concentration is not significantly (p > 0.05). The average of fibrinogen concentration in group A is 383.5 ± 104.6 mg/dl, and in group B is 467 ± 79 mg/dl. Increasing fibrinogen concentration in group B is higher than group A and the increasing is significantlystatistical difference (p

Objectives A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed. Vascular disturbance is one cause of ISSNHL and has been reported to be associated with fibrinogen. We aimed to determine whether hyperfibrinogenemia is associated with poor outcome and whether a serial change in fibrinogen level is associated with outcome. Methods Twenty-two patients with ISSNHL were enrolled. We compared the levels of fibrinogen in ISSNHL groups classified as improved and non-improved according to improvement of hearing. Blood samples were also collected from patients who visited the emergency room with coronary heart disease (CHD) as the control group. Results Initial fibrinogen level was significantly different between the non-improved and improved ISSNHL group (350.63 ± 87.20 vs. 310.71 ± 81.06. The improved ISSNHL group showed a “surge phenomenon”, in which fibrinogen started to decrease at day 5 and increased at day 26. In the non-improved group, fibrinogen remained elevated throughout the course of therapy. Conclusion It is important to measure not only the initial fibrinogen level but also to monitor its change throughout the course of therapy in order to predict the outcome of ISSNHL.

Objective Disturbance of cochlear microcirculation is considered to be the final common pathway of various inner ear diseases. Hyperfibrinogenemia causing increased plasma viscosity is a known risk factor for sudden sensorineural hearing loss and may lead to a critical reduction of cochlear blood flow. The aim of this study was to evaluate the effect of a substantial reduction of plasma fibrinogen levels by drug-induced defibrinogenation for the treatment of acute hearing loss in vivo. Methods Acute hearing loss was induced by hyperfibrinogenemia (i.v. injection of 330 mg/kg BW fibrinogen), using a guinea pig animal model. Parameters of cochlear microcirculation and hearing thresholds were quantified by intravital microscopy and evoked response audiometry. After obtaining baseline values, the course of hearing loss and disturbances of microcirculation were investigated under influence of intravenous defibrinogenation therapy (ancrod), corticosteroid, or placebo treatment, using 5 animals/group. Results Acute hyperfibrinogenemia caused hearing loss from 10 ± 7 to 26 ± 10 dB SPL at baseline. Drug-induced reduction of fibrinogen levels showed a significant increase of cochlear microcirculation (1.6-fold) and recovered hearing threshold (11 ± 6 dB SPL). Placebo or corticosteroid treatment had no effect on hearing loss (35 ± 7 dB SPL and 32 ± 18 dB SPL, respectively). Conclusion Acute hyperfibrinogenemia resulted in hearing loss. Drug-induced reduction of elevated fibrinogen levels caused an increase in cochlear blood flow and a decrease in hearing thresholds. Placebo or corticosteroid treatment had no effect. Reduction of plasma fibrinogen levels could serve as a clinical treatment option for acute hearing loss.

Backgrounds Cancer progression has been associated with host hemostasis system. Whether preoperative plasma hemostasis factors can predict survival in colorectal cancer is quite intriguing. Methods We conducted a prospective cohort study to validate the prognostic significance of three hemostasis parameters - fibrinogen, fibrin degradation products (FDPs) and D-dimer - in non-metastatic colorectal cancer patients treated with curative resection. Results All three parameters were positively correlated with C reactive protein (CRP) levels and Glasgow Prognostic scores (GPS). In univariate cox hazards regression model, as continuous variables, both fibrinogen (HR: 1.07, 95%CI: 1.01-1.13) and FDPs (HR: 1.17, 95%CI: 1.05-1.31) were prognostic, while D-dimer levels were not. Patients with hyperfibrinogenemia had a 2.12-fold increased mortality risk compared with patients without hyperfibrinogenemia. Patients with positive FDPs had a 3.68-fold increased mortality risk compared with patients with negative FDPs. In multivariate models, hyperfibrinogenemia was prognostic (HR: 3.39, 95%CI: 1.34-8.67) in patients with normal GPS scores. Conclusions Preoperative fibrinogen levels appeared as an independent mortality risk factor in non-metastatic colorectal cancer patients with normal GPS scores. Fibrinogen could be a reliable marker to identify high risk patients for those without systematic inflammation responses.