| 【Objective】In order to explore the possible causes,clinical outcomes and related characteristics of elderly hospitalized patients with hypofibrinogenemia,we retrospectively analyzed the clinical features of elderly hospitalized patients with low fibrinogen through collecting clinical data of aged patients in hospital with hypofibrinogenemia.【Methods】There were 548 cases of elderly patients with hypofibrinogenemia aged 65 years or older in our hospital.According to fibrinogen(FIB)concentration,they were divided into three groups: mild hypofibrinogenemia group(1.5g / L≤FIB <2g/L),moderate hypofibrinogenemia group(1g / L≤FIB<1.5g / L)and severe hypofibrinogenemia group(FIB <1g / L).Clinical data of all patients were collected such as age,gender,first diagnosis,medication history,treatment and prognosis.AST、ALT、GGT、ALP、ALB、GLB、Cr-S、TC、HLD-C、HSCRP、PAB were detected in serum of all groups.We recorded the results of the test of urine and feces.Leukocyte count,lymphocyte count,neutrophil count,hemoglobin and platelet count were analyzed by hematology analyzer.The clinical data was analyzed by the statistical software SPSS 18.0.Measurement data with normal distribution was expressed by mean ± standard deviation,and the mean of the groups were compared by one-way anova;measurement data with the skewness distribution was expressed by median and interquartile,and compared by rank-sum test;count data to the number of cases between the three groups were compared by chi-square test.Take death and survival as binary dependent variable,make Binary Logistic Regression analysis using SPSS 18.0 statistic software.Pearson correlation coefficient was employed to analyze the data.The receiver-operator characteristic(ROC)curve was plotted to predict the optimal neutrophil/lymphocyte ratio(NLR)values for predicting hospitalized death cases in elderly patients with hypofibrinogenemia.【Results】1、The age of severe hypofibrinogenemia group and mild group were(74.75±7.152)and(72.43±6.171)years old separately(p<0.05).The age of the moderate group was(73.66±6.122)years old,compared with the severe group and the mild group,no difference was found(p>0.05).Among the 548 elderly patients,there were 256 males(63.5%)in the mild hypofibrinogenemia group,65 males(69.1%)in the moderate group,and 22 males(43.1%)in the severe group.Differences were found between the severe group with the mild and moderate groups.2、Of 548 elderly patients,123(22.4%)had traumatic or hemorrhagic diseases,69(12.6%)had inflammatory diseases,58(10.6%)had tumors,and 49(8.9%)had liver diseases.There were 57 cases of cerebrovascular disease(10.4%)and 94 cases of cardiovascular disease(17.2%).The three main causes in the severe hypofibrinogenemia group were traumatic or hemorrhagic diseases,inflammation,and tumors.In the moderate group,there were traumatic or hemorrhagic diseases,inflammation,and cardiovascular diseases.Cardiovascular diseases,traumatic or hemorrhagic diseases,and cerebrovascular diseases were common diseases in the mild group.The rates of mortality in mild,moderate and severe hypofibrinogenemia groups were 1.7%,9.6%,and 15.7% respectively.The rates in moderate and severe groups were higher than the mild group,p<0.05.Between the severe and moderate group,no difference was found(p=0.275).Fibrinogen concentration had an association with in-hospital mortality in elderly hospitalized patients with hypofibrinogenemia[odds ratios: fibrinogen <1 g/L,10.525(95% confidence interval(CI)3.639-30.442);1-1.5 g/L,5.99(95% CI 2.170-16.531),1.5-2 g/L reference category].3、Of 548 elderly patients with hypofibrinogenemia,255 patients were detected stool routine,40 patients’ fecal occult blood were positive in examination of stool,including 22 patients in the mild group(11.5%,22/192),8 patients in the moderate group(19%,8/42),10 patients in the severe group(47.6%,10/21).471 elderly patients were examined with routine urianlysi.353 in the mild hypofibrinogenemia group,108(30.6%)had urine occult blood.76 in the moderate group,31(40.8%)had urine occult blood.42 patients in the severe group,23 patients with urine occult blood,accounting for 54.8%.4、In elderly patients with hypofibrinogenemia,the median(interquartile range)for the HSCRP in the severe group was 8.2(1.9-14.5)mg/L,which was significantly higher than that in the moderate group with a median of 4.0(1.4-11.4)mg/L and the mild group with a median of 1.1(0.6-3.1)mg/L.Differences were found in the those groups,p<0.05.Albumin was(35.01±5.18)g/L in the moderate hypofibrinogenemia group,(34.71±6.89)g/L in severe group.They were lower than that in the mild group,(39.15±4.76)g/L,p=0.000.There was no significant difference between the moderate and the severe group,p=0.989.Prealbumin was(175.83±78.19)mg/L in the moderate hyfibrinogenemia group,(158.70±61.95)mg/L in the severe group,and(215.12±65.63)mg/L in the mild group.No differences were found in the first 2 groups,they were lower than the mild group,(p=0.000).In the mild group,HLD-C was(1.32±0.35)mmol/L;in the moderate group,it was(1.15±0.37)mmol/L;in the severe group,it was(1.20±0.42)mmol/L.Differences were found between mild group and the other groups(compared with moderate group and severe group,p= 0.000、0.018 separately),no difference was found between moderate group and severe group(p=0.455).The amount of aspartate aminotransferase,alanine aminotransferase,γ-glutamyltransferase,globulin and alkaline phosphatase were within normal limits.Creatinine and total cholesterol were not statistically significant between groups.Association analysis showed that FIB levels were negatively related with γ-glutamyltransferase,globulin,high-sensitivity C-reactive protein(r=-0.113,-0.096,-0.338);while showed positive relation with albumin,white ball ratio,total cholesterol,high density cholesterol,prealbumin(r= 0.320,0.230,0.088,0.156,0.275).5、In elderly patients with hypofibrinogenemia,the neutrophil count was the lowest in the mild group(4.00±2.43)*10^9/L,which was lower than the moderate group(5.15±3.10)*10^9/ L and the severe groups(6.26±3.37)*10^9/L,p=0.003 and p= 0.000.There was no significant difference between the moderate and severe groups.The lymphocyte count was the lowest in the severe hypofibrinogenemia group[(1.00±0.54)*10^9/L];it was(1.14±0.64)*10^9/L in the moderate group,and(1.43±0.64)*10^9/L in the mild group.There was no significant difference between the moderate and severe groups,p=0.196,both groups were lower than it in the mild group.Platelet counts of the mild,moderate,and severe hypofibrinogenemia groups were within normal limits;the hemoglobin in the group with mild hypofibrinogenemia was(127.37±23.87)g/L.It was(116.26±26.59)g/L in the moderate group,(104.86±27.30)g/L in the severe group.Differences were found when mild group compared with moderate group,severe group,p< 0.05;no difference was found between moderate group and severe group,p>0.05;the median neutrophil/lymphocyte ratio(NLR)in severe hypofibrinogenemia group was 5.7(interquartile range: 2.8-11.8),which was significantly higher than in the moderate group 4.1(interquartile range:2.1-8.3)and in the mild group 2.3(interquartile range : 1.6-4.0).The difference was statistically significant.The moderate and severe groups were compared,p< 0.05.Association analysis showed that FIB levels were negatively related with white blood cell counts,neutrophil counts,neutrophil/lymphocyte ratios(r=-0.207,-0.275,-0.216);while showed positive relation with platelet count,hemoglobin,lymphocyte count(r=0.174,0.299,0.234).6、ROC curve analysis illustrated that the AUC(areas under the ROC curve)values for NLR level for predicting hospitalized death cases in elderly hospitalized patients with hypofibrinogenemia is 0.842(95%CI:0.75-0.935,p=0.000).When we designate the cutoff point of NLR value as 1.5585,the sensitivity(95.8%)and the specificity(18.9%)were highest in predicting hospitalized death cases in elderly patients with hypofibrinogenemia.【Conclusion】1.In elderly patients with hypofibrinogenemia,as the fibrinogen level decreases,the risk of death increase.2.The three main causes in the severe hypofibrinogenemia group were traumatic or hemorrhagic diseases,inflammation,and tumors.3.As the fibrinogen level decreases,the occurrence of inflammation in the old increase.4.FIB levels was related with high-sensitivity C-reactive proteinin in the old with hypofibrinogenemia.As the fibrinogen level decreases,the HSCRP level and the proportion of abnormal occurrence increase.5.The neutrophil count and neutrophil/lymphocyte ratio were increase in the elderly patients with severe hypofibrinogenemia,it is suggesting the existence of inflammatory diseases.6.Neutrophil/lymphocyte ratios may be maekers of prognosis of elderly patients with hypofibrinogenemia.7.In the elderly patients with hypofibrinogenemia,as fibrinogen levels decreased,the incidence of anemia also increased. |
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