Correlation Between Plasma Fibrinogen And Renal Function In Patients With Acute Pulmonary Embolism

Objectives:Acute pulmonary embolism(APE)is a clinical pathophysiological syndrome with pulmonary thromboembolism as the most common.It is caused by various endogenous or exogenous emboli blocking the pulmonary artery and its branches.The disease has the characteristics of rapid progress,easy missed diagnosis and misdiagnosis,and high mortality.Early and rapid diagnosis of ape is of great significance for treatment.At present,the clinical observation indexes for early diagnosis of ape are mainly D-dimer,ECG and lower extremity deep vein color Doppler ultrasound.There are relatively few studies on the detection indexes of plasma fibrinogen(FIB)and renal function in the early identification of ape.This topic studies the correlation between plasma fibrinogen and renal function in patients with ape,To evaluate its clinical value as a coagulation monitoring index in different renal function states.Method:In this retrospective study,193 patients(91 males and 102 females)with APE were selected from the First Affiliated Hospital of Jinan University(from January 2015 to June 2021).A standard questionnaire was used to record the information of the patients,including basic information,current medical history,past medical history,personal history,and auxiliary examinations.The eGFR was calculated by MDRD formula,and the subjects were divided into 4groups according to eGFR: There were 64 cases in the group with normal renal function in ckd1 stage,74 cases in the group with mild renal function injury in ckd2 stage,42 cases in the group with moderate renal function injury in ckd3 stage,and 13 cases in the group with severe renal function injury in ckd4-5 stage.Fibrinogen(FIB),activated partial thromboplastin time(APTT),prothrombin time(PT),platelet(PLT),sex and age were compared among different glomerular filtration rate groups.There were differences in hospitalization days,smoking,systolic blood pressure,body mass index(BMI),heart rate,blood gas P02,C-reactive protein(CRP),white blood cells(WBC),hemoglobin,uric acid,amylase,total cholesterol,D-dimer,brain natriuretic peptide(BNP),troponin,urea,cystatin C,serum creatinine and urine protein.The correlation between plasma fibrinogen(FIB)and other coagulation indexes(APTT,PT,PLT)in different groups was analyzed,and the correlation between plasma fibrinogen(FIB)and urea,cystatin C,serum creatinine and urine protein in different groups was analyzed;Finally,the regression analysis of renal function and the regression analysis of fibrinogen and eGFR were performed.Result:(1)There were no significant differences in gender,hospitalization days,smoking,BMI,systolic blood pressure,heart rate,CRP,WBC,hemoglobin,total cholesterol and D-dimer among the four groups(P> 0.05);1.There were significant differences in age,blood gas PO2,uric acid,amylase,BNP and troponin between the two groups(P < 0.05).(2)Fibrinogen was the only coagulation index in the four groups(P = 0.016).Fibrinogen in severe renal injury group was higher than that in mild renal impairment group.It was considered that fibrinogen could be used as one of the monitoring indexes of coagulation index in patients with pulmonary embolism,and that the more serious the renal function was,the higher the level of fibrinogen was;There was no significant difference in APTT,PT and platelet levels among the three groups(P > 0.05).There were significant differences in renal function indicators among the four groups(P < 0.05),and severe renal injury group was higher than normal renal function group,mild renal impairment group and moderate renal function injury group,indicating that the more severe the glomerular filtration rate,the higher the levels of urea,cystatin C,serum creatinine and urinary protein.(3)Cystatin C was positively correlated with fibrinogen in normal renal function group(R =0.2980,P < 0.05),while urea,serum creatinine and urine protein were not correlated with fibrinogen(P > 0.05);In mild renal impairment group,all parameters were not correlated with fibrinogen(P > 0.05),while in moderate renal function injury group,urinary protein was positively correlated with fibrinogen(R = 0.3480,P < 0.05),and urea,cystatin C and serum creatinine were not correlated with fibrin(P > 0.05);In severe renal injury group group,Cystatin C was negatively correlated with fibrinogen(R =-0.604 0,P < 0.05),and serum creatinine was positively correlated with fibrinogen(R = 0.655 0,P < 0.05),while urea and urine protein were not correlated with fibrin(P > 0.05).It is considered that there is a significant correlation between fibrinogen and renal function monitoring indicators,and the higher the level of fibrinogen,the more serious the renal function monitoring indicators.(4)In the regression analysis of renal function of the four groups,in model 1,urea in normal renal function group and moderate renal function injury group was the related factor affecting fibrinogen(P < 0.05),in which the higher the urea level in normal renal function group,the higher the fibrinogen level(β = 0.192);the lower the urea level in moderate renal function injury group,the higher the fibrinogen level(β =-0.072).In model 2,Normal renal function group and Severe renal injury group cystatins were related to fibrinogen(P <0.05).In normal renal function group,the higher the level of Cystatin C,the higher the level of fibrinogen(β = 2.236);in severe renal injury group,the lower the level of Cystatin C,the higher level of fibrinogen(β =-1.654).In model 3,serum creatinine was a factor related to fibrinogen in severe renal injury group(P < 0.05),and the higher the serum creatinine level was,the higher the fibrinogen level was(β = 0.017).Multiple linear regression analysis with eGFR as the independent variable and fibrinogen as the dependent variable showed that eGFR was a related factor affecting FIB in moderate renal function injury group and severe renal injury group(P < 0.05).Fibrinogen was strongly correlated with renal function,and the lower the eGFR level,the higher the FIB level(β =-0.108,-0.209).Conclusion:(1)Fibrinogen can be used as one of the important monitoring indexes of coagulation function in the occurrence of pulmonary embolism.(2)The elevated level of blood fibrinogen in patients with ape can reflect the degree of renal function injury.The higher the level,the more serious the renal function injury.