Association Of FIB,D-Dimer And Thromboelastography With Clinical Indicators And Prognosis In Patients With Primary Diagnosed Multiple Myeloma

Objective:To investigate the association between fibrinogen(FIB)and D-dimer and clinicopathological features and survival of patients with a primary diagnosis of MM.To elucidate the value of FIB and D-dimer in the prognosis of MM,and to conduct a preliminary analysis of whether thromboelastography(TEG)related indicators can predict the survival outcome of MM,with a view to providing a reference for the prognostic assessment of the disease.Methods:1.Retrospective analysis of MM patients who visited Lanzhou University First Hospital for the first time from January 1,2016 to December 31,2022,selected 100patients as research objects strictly according to the inclusion and exclusion criteria,and screened out the patients who were diagnosed at the first visit.A total of 21patients underwent TEG detection.2.Optimal cut-off values for FIB and D-dimer were determined from the subjects’work curves and used as cut-off values to divide patients into one team of high value and one team of low value.To analyse the differences between the groups with high and low values of each FIB and D-dimer before chemotherapy in terms of clinicopathological characteristics and overall survival(OS),and to analyse the risk factors affecting the prognosis of patients with a first diagnosis of MM.3.To analyze the correlation between R value,Angle of Angle,MA value,CI value and other clinical indicators in TEG and to analyze their significance on the prognosis of patients with primary diagnosis of MM.Results:1.The optimal cut-off value of FIB=2.97 g/L was used as the cut-off value and the analysis showed that high FIB was positively correlated with the DS stage of the patients,the higher the FIB value,the later the DS stage(P=0.049);and negatively correlated with the HB level,the higher the FIB value,the lower the HB level(P=0.002).2.The optimal cut-off value of D-dimer=1.08ug/m L was used as the cut-off value and the analysis showed that the D-dimer level was positively associated with patient age and stage of DS,with the higher the D-dimer level,the older the patients were(P=0.027)and the later the stage of DS(P=0.024).3.The median OS time was shorter overall for patients in the high D-dimer group than in the low D-dimer group,with a statistically significant difference(P=0.041).The difference in OS time between the high FIB and low FIB groups was not statistically significant.4.Kaplan-Meier survival analysis of other clinical variables showed that elevated ISS and HB<85 g/L were highly associated with OS in MM patients(all P<0.001);PLT≥100×10~9/L was associated with OS in MM patients,with a statistically significant difference(P=0.013);ALP≥5/L was associated with OS in MM patients,with a statistically significant difference(P=0.027);β2-MG≥5.5mg/L was associated with OS in MM patients,with a statistically significant difference(P=0.013).5.The univariate binary logistic regression model for each of the patients’clinical indicators yielded the following results:D-dimer≥1.08ug/ml(P=0.023),HB level(P=0.003),PLT level(P=0.044),ALP level(P=0.029),β2-MG level(P=0.026),ISS stage(P=0.005)were risk factors affecting MM patients’prognosis.Further multivariate analysis of these risk factors showed that High ISS stage(P=0.046),HB<85g/L(P=0.037),PLT>100×10~9/L(P=0.045)were independent adverse prognostic factors for MM patients.6.The 21 patients collected who underwent TEG testing at the time of initial consultation were used as study subjects to analyse the correlation between R value,Angle,MA value and CI value in TEG and other clinical indicators respectively,and it was concluded that Angle and MA value in TEG showed moderately strong negative correlation withβ2-MG,with correlation coefficient r values of-0.539(P=0.014)and-0.547(P=0.013).Using patient survival outcome as the observed variable,univariate analysis of the TEG indicators yielded angle of Angle as a prognostic risk factor for MM patients(P=0.045).The angle of Angle was also substituted into the ROC curve,and it was found that angle of Angle had a predictive value for survival outcome in patients with primary diagnosis of MM(AUC=0.794,P=0.039).Conclusions:1.Higher plasma FIB values and later stage DS and lower HB levels in patients with primary MM;higher D-dimer values and older age and later stage DS,suggesting an association with markers of worse cancer burden and prognosis.2.Median OS time was shorter in patients with high D-dimer than in patients with low D-dimer.3.High ISS stage,HB<85g/L,PLT>100×109/L were independent adverse prognostic factors for MM patients.4.Angle of Angle in TEG assay has a predictive value for survival of MM patients.