Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury
Objectives Coagulation factors participates in the inflammatory cascade, known to play a crucial role in the development of acute kidney injury (AKI). Thus, it’s likely that some factors may be associated with AKI. Among them, low levels of fibrinogen and antithrombin III (ATIII) activity have been...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Renal Failure |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2142138 |
| _version_ | 1811232806427164672 |
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| author | Guangyuan Zhang Lei Zhang Sun Si Tiancheng Jiang Yi Xia Yongkun Zhu Xiangyu Zhang Chi Yao Ming Chen Shuqiu Chen |
| author_facet | Guangyuan Zhang Lei Zhang Sun Si Tiancheng Jiang Yi Xia Yongkun Zhu Xiangyu Zhang Chi Yao Ming Chen Shuqiu Chen |
| author_sort | Guangyuan Zhang |
| collection | DOAJ |
| description | Objectives Coagulation factors participates in the inflammatory cascade, known to play a crucial role in the development of acute kidney injury (AKI). Thus, it’s likely that some factors may be associated with AKI. Among them, low levels of fibrinogen and antithrombin III (ATIII) activity have been proved to increase mortality in patients with sepsis. Moreover, they are also reported to be associated with higher incidence of AKI. However, the association between coagulation parameters, especially fibrinogen and ATIII, and prognosis of AKI has not been examined.Methods Data were acquired from Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) version 1.0. Cox proportional hazards regression model was used to estimate the relationship between coagulation parameters and in-hospital mortality in critically ill patients with AKI. Subgroup analysis was also conducted to assess the robustness of the association. Restricted cubic spline (RCS) curve was utilized to examine the nonlinear relationships between fibrinogen or ATIII and in-hospital mortality. Kaplan–Meier method was used to estimate cumulative incidence of mortality by fibrinogen or ATIII levels. Receiver-operating characteristic (ROC) curve was plotted and area under curve was calculated to evaluate predictive ability of fibrinogen or ATIII.Results A total of 5914 eligible patients were enrolled in fibrinogen cohort study and 115 patients were eligible for ATIII cohort study. The baseline of low fibrinogen (<150 mg/dL) or ATIII (<80%) activity was associated with significantly higher in-hospital mortality (fibrinogen HR [95% CIs] 2.01 [1.79, 2.27]; ATIII 3.73 [1.11, 12.54]). The HR [95% CIs] of low fibrinogen remained significant 1.29 (1.13, 1.48) in multivariate analysis. The RCS curve showed nearly linear relationship. Subgroup analysis also proved the robustness of the association between fibrinogen and in-hospital mortality. Kaplan–Meier survival curve and ROC demonstrated the predictive capability of fibrinogen and ATIII.Conclusion Low fibrinogen is an independent predictor of in-hospital mortality in critically ill patients with AKI. Low ATIII activity is also likely to impact the risk of in-hospital death. |
| first_indexed | 2024-04-12T11:10:28Z |
| format | Article |
| id | doaj.art-ccb208ffd0844c3eab77419b095be51b |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-04-12T11:10:28Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-ccb208ffd0844c3eab77419b095be51b2022-12-22T03:35:38ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492022-12-014411938194710.1080/0886022X.2022.2142138Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injuryGuangyuan Zhang0Lei Zhang1Sun Si2Tiancheng Jiang3Yi Xia4Yongkun Zhu5Xiangyu Zhang6Chi Yao7Ming Chen8Shuqiu Chen9Department of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaInstitute of Urology, Medical School, Southeast University, Nanjing, ChinaInstitute of Urology, Medical School, Southeast University, Nanjing, ChinaInstitute of Urology, Medical School, Southeast University, Nanjing, ChinaInstitute of Urology, Medical School, Southeast University, Nanjing, ChinaDepartment of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Urology, Zhongda Hospital, Southeast University, Nanjing, ChinaObjectives Coagulation factors participates in the inflammatory cascade, known to play a crucial role in the development of acute kidney injury (AKI). Thus, it’s likely that some factors may be associated with AKI. Among them, low levels of fibrinogen and antithrombin III (ATIII) activity have been proved to increase mortality in patients with sepsis. Moreover, they are also reported to be associated with higher incidence of AKI. However, the association between coagulation parameters, especially fibrinogen and ATIII, and prognosis of AKI has not been examined.Methods Data were acquired from Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) version 1.0. Cox proportional hazards regression model was used to estimate the relationship between coagulation parameters and in-hospital mortality in critically ill patients with AKI. Subgroup analysis was also conducted to assess the robustness of the association. Restricted cubic spline (RCS) curve was utilized to examine the nonlinear relationships between fibrinogen or ATIII and in-hospital mortality. Kaplan–Meier method was used to estimate cumulative incidence of mortality by fibrinogen or ATIII levels. Receiver-operating characteristic (ROC) curve was plotted and area under curve was calculated to evaluate predictive ability of fibrinogen or ATIII.Results A total of 5914 eligible patients were enrolled in fibrinogen cohort study and 115 patients were eligible for ATIII cohort study. The baseline of low fibrinogen (<150 mg/dL) or ATIII (<80%) activity was associated with significantly higher in-hospital mortality (fibrinogen HR [95% CIs] 2.01 [1.79, 2.27]; ATIII 3.73 [1.11, 12.54]). The HR [95% CIs] of low fibrinogen remained significant 1.29 (1.13, 1.48) in multivariate analysis. The RCS curve showed nearly linear relationship. Subgroup analysis also proved the robustness of the association between fibrinogen and in-hospital mortality. Kaplan–Meier survival curve and ROC demonstrated the predictive capability of fibrinogen and ATIII.Conclusion Low fibrinogen is an independent predictor of in-hospital mortality in critically ill patients with AKI. Low ATIII activity is also likely to impact the risk of in-hospital death.https://www.tandfonline.com/doi/10.1080/0886022X.2022.2142138Coagulation parametersfibrinogenantithrombin IIIacute kidney injuryin-hospital mortality |
| spellingShingle | Guangyuan Zhang Lei Zhang Sun Si Tiancheng Jiang Yi Xia Yongkun Zhu Xiangyu Zhang Chi Yao Ming Chen Shuqiu Chen Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury Renal Failure Coagulation parameters fibrinogen antithrombin III acute kidney injury in-hospital mortality |
| title | Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury |
| title_full | Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury |
| title_fullStr | Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury |
| title_full_unstemmed | Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury |
| title_short | Fibrinogen and antithrombin III are associated with in-hospital mortality among critically ill patients with acute kidney injury |
| title_sort | fibrinogen and antithrombin iii are associated with in hospital mortality among critically ill patients with acute kidney injury |
| topic | Coagulation parameters fibrinogen antithrombin III acute kidney injury in-hospital mortality |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2142138 |
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