Fibrinogen levels are associated with bleeding in patients with primary immune thrombocytopenia

Abstract

Bleeding is the most common clinical symptom and the leading cause of death in patients with primary immune thrombocytopenia (ITP). Our research intends to verify the role of fibrinogen levels as independent determinants of bleeding. We retrospectively analyzed the relationship between fibrinogen levels and bleeding events in 463 patients. Additionally, we confirmed the impact of fibrinogen level on clot firmness in 25 patients via thrombelastography (TEG). Fibrinogen levels (median and inter-quartile range, IQR) were significantly different (p < .001) between bleeding and non-bleeding patients [258(207–314) mg/dL vs. 315(262–407) mg/dL, respectively]. Further analyzes in three subgroups based on platelet (PLT) count showed that non-bleeding patients still had higher fibrinogen levels than bleeding patients. The optimal discriminant threshold of fibrinogen in bleeding was 288.5 mg/dL according to receiver operating characteristic (ROC) curves. Patients were divided into low (LF, 230[193–258] mg/dL) and high (HF, 349[313–424] mg/dL) fibrinogen groups based on this threshold. Bleeding event rates were significantly different (LF: 84.6% vs. HF: 60.4%, P < .001) between the two groups. Multivariable analyses further confirmed these differences. Moreover, TEG parameters showed elevated clot firmness in the HF group. Our data suggest that high fibrinogen levels are associated with reduced bleeding events.

Keywords:

• Bleeding
• fibrinogen
• platelet
• primary immune thrombocytopenia
• thrombocytopenia

Acknowledgements

The authors would like to thank all the study participants and the staff of the medical record section of the Wuhan union hospital.

Disclosure of Interests

The authors state that they have no conflicts of interest for this article.

Authors’ contributions

Min Xu and Heng Mei designed the study, collected the data, and wrote the paper; Lili Luo and Mengyi Du analyzed the data; Lu Tang and Yu Hu analyzed the data and modified the grammatical structure of the article; all authors reviewed the paper and approved the final manuscript.

Additional information

Funding

The authors declare no competing financial interests. The study was supported by the National Natural Science Foundation of China (No. 81570116, 81873434 from Heng Mei).